Article

Immediate Loading of Dental Implants Placed in Periodontally Infected and Non-Infected Sites: A 4-Year Follow-Up Clinical Study

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Abstract

The aim of the present study is to compare the outcomes of immediate loading of implants in replacing teeth with and without chronic periodontal lesions at 4 years of follow-up. Thirty-seven patients were included in this study. A total of 275 implants were placed and immediately loaded in extraction sockets, 197 in periodontally infected sites (infected sites group [IG]), and 78 implants in non-infected sites (non-infected sites group [NG]). Marginal bone levels and clinical parameters (plaque accumulation and bleeding index) were evaluated at baseline and 12, 24, and 48 months after implant placement. Comparisons between IG and NG values over time were performed by the Student two-tailed t test. At 48 months of follow-up, the IG presented a survival rate of 98.9% because two implants were lost 1 month after placement; the NG reported a survival rate of 100%. The marginal bone level was 0.79 +/- 0.38 mm for the IG and 0.78 +/- 0.38 mm for the NG, plaque accumulation was 0.72 +/- 0.41 for the IG and 0.71 +/- 0.38 for the NG, and the bleeding index was 0.78 +/- 0.23 for the IG and 0.75 +/- 0.39 for the NG. No statistically significant differences were reported between the IG and NG over time and between time points. At 48 months of follow-up, dental implants that were placed and immediately loaded in periodontally infected sockets showed no significant differences compared to implants placed in uninfected sites.

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... 12,13 Contrary to the research mentioned above, specific systematic reviews and meta-analyses 14,15 offer evidence suggesting similar rates of success and survival for rapid dental implant implantation in infected sites compared to non-infected sites. Similarly, recent academic research [16][17][18][19] has also documented similar rates of success for dental implants placed promptly in both peri-apical disease-free and peri-apical disease-affected areas. ...
... Relevant articles, [16][17][18][19][20][21][22][23][24][25] between the year 2000-2023, that includes patients with apical pathosis and requires implant placement; provides the required outcomes plaque index and bleeding index of apical pathosis patients with immediate dental implantation procedures were included in this study as per the PRISMA guidelines. 26 The inclusion criteria for this study were selecting only full-text papers, while excluding studies with insufficient data, studies that were not focused on the implantation method in periodontally diseased areas, and studies that were not published in the English language. ...
... The aim of this study was to perform a systematic review and metaanalysis of the selected RCTs [16][17][18][19][20][21][22][23][24][25] to investigate the contradictory perspectives regarding the use of an immediate implant placement method in patients with apical pathosis. The main findings of the included studies are as follows: Lindeboom et al. 16 assess the clinical efficacy of implant insertion in chronic periapical infected areas in their randomized controlled trial (RCT) involving 50 patients. ...
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Objectives It is commonly accepted that immediate implantation is the best option for patients since it shortens the time patients must wait for ultimate restoration and provides a predictable functional and aesthetic result. However, this approach is still controversial in patients with apical pathosis. The goal of this systematic review and meta-analysis was to determine the efficacy of immediate implant insertion in patients with apical pathosis. Material and methods Between 2000 and 2023, PRISMA-compliant keywords were used to search PubMed, MEDLINE, CENTRAL, and the Cochrane Library. All English-language clinical studies that met PICOS criteria were included in a manual search. The included studies' demographic profile and event data for immediate dental implantation success in patients with or without apical pathosis were meta-analyzed using RevMan. The implant survival rate was assessed using risk ratio of plaque index and bleeding index. Begg's test using MedCalc and RevMan risk of bias assessment assessed publication bias. Results A meta-analysis of 10 trials with 849 dental implantation patients found a substantial difference in initial implant placement success rates in infected sites. The pooled risk ratio for plaque index is 0.59 (95% CI: 0.36–0.96) with heterogeneity of Tau² = 0.62, chi² = 109.69, df = 11, I² = 90%, z = 2.12, and p < 0.05. While, the pooled risk ratio for bleeding index is 0.77 (95% CI: 0.60 to 0.98) with Tau² = 0.16, chi² = 103.67, df = 11, I² = 89%, z = 2.12, and p < 0.05. The pooled odds ratio of implant survival rate is 2.08 (95% CI: 1.56 to 1.79) with Tau² 0.16; chi² 52.43; df 9; I² 83%; z 4.93 and p < 0.05. As evidenced by the funnel plot and statistically insignificant Begg's test p values of 0.45. Conclusion The placement of immediate implants in locations affected by apical pathosis is a clinically beneficial surgery, resulting in favorable aesthetic and functional outcomes for patients.
... Moreover, studies reported that immediate dental implant placement in an extraction site with a periapical infection did not result in a greater incidence of complication than the placement of a dental implant in an uninfected site (7,36). If appropriate clinical procedures such as antibiotic administration, thorough cleaning, and alveolar debridement are undertaken before the surgical surgery, elimination of the cultured microorganisms as well as a reduction in the inflammatory response and bone resorption would occur and immediate placement of implants would result in a favorable type of tissue integration and this is in agreement with some authors (7,33,(36)(37)(38)(39)(40). In contrast, Crepsi et.al. ...
... From the results of our study, the postoperative pain was mild and of short duration as it was a minimally invasive surgery and this results had a coincidence with other studies (37,41,42). Postoperative edema was not severe and was confined to the surgical area and this was tested by some studies with the same findings (8,38,41) and to a study that revealed minor gingival swelling in the first days for the group that was scheduled for granulomatous tissue removal (43). Healing of implants was free of complications and was generally uneventful. ...
... Meticulous debridement of the periapical lesions and extending implant site preparation beyond the root apex ≥ 4 mm was enough to promote the healing, to achieve a good primary stability and to reduce lesions size throughout the 6 months follow up period. This was in accordance to some studies (8,27,38,45) Some studies supported application of PRF after immediate implant (46)(47)(48). One of the most critical aspects of effective implant therapy is preserving peri-implant bone. ...
... But new research has shown that immediate implants placed in alveolae with periapical pathology in animal models achieve the same success rates as those placed in alveolae without pathology (19)(20)(21)(22). Five prospective controlled clinical trials have been published assessing clinical and radiological variables for immediate post-extraction implants placed in patients with periapical pathology (23)(24)(25)(26)(27). It was found that success rates were similar between cases with and without periapical pathology; three works with 1-year follow-up (23,24,27) and two works with 3-and 4-year follow-up periods respectively (25,26). ...
... Five prospective controlled clinical trials have been published assessing clinical and radiological variables for immediate post-extraction implants placed in patients with periapical pathology (23)(24)(25)(26)(27). It was found that success rates were similar between cases with and without periapical pathology; three works with 1-year follow-up (23,24,27) and two works with 3-and 4-year follow-up periods respectively (25,26). To date, only one trial has been conducted of immediate implant placement in alveolae with periapical pathology that has also performed immediate prosthetic provisionalization, but this work lacked a control group of cases without periapical pathology (28). ...
... These findings concur with previous animal studies, which have observed similar implant success rates for immediate implants placed in alveolae with and without periapical pathology (19)(20)(21)(22). The present results also coincide with clinical trials conducted by other authors (23)(24)(25)(26)(27), who obtained excellent results with implants placed in post-extraction alveolae with previous periapical pathology, applying a rigorous protocol of curettage and debridement of the lesions, although these authors did not perform immediate prosthetic provisionalization. To obtain these good and predictable results, all the authors agree (23-27) (as we do) that the most important thing is a good protocol of alveolus debridement and meticulous cleaning after tooth extraction: first, all granulation tissue should be carefully removed with curettage and debridement; second, alveolae should be disinfected with 0.12% chlorhexidine-soaked gauzes (applied for one minute); and finally, abundantly irrigation with physiological serum and 0.12% chlorhexidine is necessary to eliminate any remaining detritus from the alveolus. ...
Article
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Background: Few studies have reported the outcomes of immediate placement at infected post-extraction sites. The aim of this study was to compare clinical and radiological outcomes of immediately placed implants with immediate prosthetic provisionalization in sockets with or without acute periapical pathology. Material and methods: A total of 100 patients with immediately placed implants with immediate provisionalization and 1- year of follow up were included (50 patients with acute periapical pathology and a control group of 50 patients without acute periapical pathology). Clinical parameters (bleeding on probing, buccal keratinized mucosa width, clinical recession, and probing depth) and radiological parameters (distance from implant shoulder to first point of bone-to-implant contact [IS-BIC]) were assessed. Results: Clinical parameters showed no significant differences between the study and control groups after 1-year follow up (p>0.05). IS-BIC presented the following values: 0.35 ± 0.51 mm (study group) and 0.15 ± 0.87 mm (control), without significant differences between the groups (p=0.160). None of the 50 radiographs of immediate implants placed in sockets with periapical pathology revealed retrograde peri-implantitis. Conclusions: Immediate placement of implants with immediate prosthetic provisionalization at sites with acute periapical pathology can be a successful treatment modality for at least 1-year.
... A total of 12 full-articles were reviewed for inclusion and exclusion criteria in order to make the final decision. After a detailed review, nine records met all the required criteria and were included in this review [18][19][20][21][22][23][24][25][26]. Figure 1 shows the PRISMA flow diagram which demonstrates the number of publications identified, screened, assessed for eligibility and included in this review. ...
... The characteristics and details of the treatment procedures of the included studies are presented in Table 5 and 6. Three of the included clinical trials were of retrospective design [24][25][26] and the other remaining six were of prospective design [18][19][20][21][22][23]. In total, a pool of 1346 patients and 2281 sockets were used in this present systematic review. ...
... A total of 933 immediate implants were placed in infected sites and 1348 in non-infected sites. Seven of the studies included smoking patients [18][19][20][21][24][25][26]. Only two of them specified the total number of smokers [19,24]. ...
Article
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Objectives: The aim of this systematic review is to compare immediate implant placement in infected extraction sockets with non-infected extraction sockets in terms of implant survival and function. Material and Methods: An electronic search was conducted in PubMed, ScienceDirect, ISI Web of Knowledge and Google Scholar between January 2010 and February 2020. Studies evaluating implant survival rate and main clinical parameters were included for a qualitative and quantitative analysis. Results: In total, nine studies were included and a pool of 2281 sockets were analysed. Compared with the non-infected group, the infected group showed no significant differences in implant survival rates (risk ratio [RR] = 0.99; 95% confidence interval [CI] = 0.98 to 1; P = 0.08). No significant statistical differences were found in marginal bone level (mean difference [MD] = -0.03; 95% CI = -0.1 to 0.04; P = 0.41), marginal gingival level (MD = -0.07; 95% CI = -0.17 to 0.04; P = 0.23), probing depth (MD = 0.06; 95% CI = -0.24 to 0.36; P = 0.7), modified bleeding index (MD = -0.00162196; 95% CI = -0.09 to 0.09; P = 0.97) and slight but significant changes were seen in width of keratinized gingiva (MD = 0.25; 95% CI = -0.3 to 0.8; P = 0.38) between the groups at the latest follow-up. Conclusions: There were no significant difference in implant survival rates, marginal bone level, marginal gingival level, modified bleeding index and probing depth between infected sockets and non-infected sockets. However, slight but significant changes were seen in width of keratinized gingiva favouring the non-infected group.
... Online searches yielded a total of 3.253 initial hits considering all databases, as follows: (41)(42)(43)(44)(45)(46)(47)(48). Figure 1 summarizes all steps performed on the present systematic review. Characteristics of included studies are summarized on Table 2. Risk of bias assessment showed that included studies were of unclear risk of bias, whereas all papers presented low risk of bias for the items "incomplete outcome data", "selective reporting", and other bias; however, the item "blinding of participants and personnel" presented high risk of bias in all included studies. ...
... Implant survival rate: the eight included studies reported this outcome, which ranged from 90.8% 100.0% (41)(42)(43)(44)(45)(46)(47)(48). Meta-analysis was performed for implant failure, which showed statistically significant difference (risk ratio = 2.99; 95% confidence interval: 1.04, 8.56; p= 0.04; 935 implants; i2= 0%). ...
... Figure 3(a) shows the forest plot for implant failure. Peri-implant bone loss: five studies reported this outcome and it did not present statistical difference on the meta-analysis (mean difference= -0.03; 95% confidence interval: -0.09, 0.04; p=0.46; 399 implants; i2= 0%). Figure 3(b) shows the forest plot for peri-implant bone loss (42,43,(45)(46)(47). Meta-analysis for additional peri-implant outcomes are shown of Figure 3(c) to (f): the outcomes bleeding index and plaque index were reported in 5 studies, totaling 399 assessed immediate dental implants and there were no statistical difference on meta-analysis, which presented, respectively, the following results: mean difference= 0.05; 95% confidence interval:-0.01, ...
Article
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Background: Alveolar infection is known as a risk factor for implant failure. Current meta-analysis on the theme could not prove statistically that immediate dental implants placed into infected sites have a higher risk of failure than immediate dental implants placed into non-infected sites. The purpose of this meta-analysis was to determine the effectiveness of immediate dental implants placed into infected versus non-infected sites. Material and methods: Seven databases were sought by two reviewers. Randomized or non-randomized clinical trials that compared the placement of dental implants into infected versus non-infected sites were eligible for the study. Exclusion criteria were: papers in which the survival rate was not the primary outcome; papers without a control group; studies with less than one year of follow-up; studies whose patients did not receive antibiotic therapy; studies with medically compromised patients; duplicated papers. Risk of bias assessment was performed with the Cochrane Collaboration tool. Results: Of the 3.253 initial hits, 8 studies were included in both qualitative and quantitative synthesis (kappa=0.90; very good agreement). Forest plot for implant failure showed that immediate implants placed into infected sites presented a statistically significant risk of failure that is almost 3 times higher than when placed into non-infected sites (risk ratio= 2.99; 95% confidence interval: 1.04, 8.56; p= 0.04; 935 implants; i2= 0%). Peri-implant outcomes showed no statistical difference. Conclusions: Immediate dental implants placed into infected sites presented a statistically significant higher risk of failure than immediate dental implants placed into non-infected sites. Peri-implant outcomes were not statistically affected in this intervention.
... Seu uso em relação à carga tradicional traz como vantagem a manutenção da forma essencial do tecido mole, em particular das papilas interproximais, maximizando os resultados estéticos 11 . O uso de provisório está associado à manutenção do perfil de emergência do dente extraído, à preservação da arquitetura óssea e gengival, promovendo benefício psicológico e satisfação estética e funcional para o paciente 3,4,6,26,27,[31][32][33] . ...
... Inúmeros autores compararam a instalação de implantes em área com ausência e presença de infecção e a maioria dessas pesquisas obtiveram resultados semelhantes para os dois sítios [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] (Quadro 1). Esses resultados bem sucedidos podem ser explicados por eventos biológicos durante a cicatrização como os princípios biológicos, cirúrgicos, biomecânicos, a estabilidade do implante, controle de carga e a resposta inflamatória 11 . ...
... Inúmeros autores compararam a instalação de implantes em área com ausência e presença de infecção e a maioria dessas pesquisas obtiveram resultados semelhantes para os dois sítios [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] (Quadro 1). Esses resultados bem sucedidos podem ser explicados por eventos biológicos durante a cicatrização como os princípios biológicos, cirúrgicos, biomecânicos, a estabilidade do implante, controle de carga e a resposta inflamatória 11 . ...
Article
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A busca por novas técnicas cirúrgicas preservando a integridade dos tecidos periodontais associado à reabilitação com implantes dentários favorece a qualidade estética e funcional, garantindo assim a satisfação dos pacientes. O objetivo do trabalho foi demonstrar a reabilitação com implante imediato em alvéolo com infecção associado a provisionalização imediata e proservação de 36 meses após a reabilitação final. Paciente apresentou-se com elemento 24 com mobilidade grau III, defeitos ósseos ao redor do dente, drenagem purulenta e bolsa profunda à sondagem de (>7 mm). Foi utilizado o protocolo de regeneração óssea guiada (ROG) com o substituto ósseo para preenchimento do “gap” entre o implante e o osso alveolar, com o uso de tela de titânio para ganho ósseo vertical e horizontal e membranas autólogas de fibrina obtidas através do processo de centrifugação e preparo. Após o período de osseointegração, foram realizados procedimentos de moldagem personalizada para a reabilitação final com prótese metalocerâmica. No período de 36 meses de acompanhamento clínico e radiográfico não há sintomatologia dolorosa, infecção, mobilidade do implante e perda óssea peri-implantar acentuada. O paciente apresentou-se satisfeito com relação à estética e função protética.Descritores: Infecção; Implantes Dentários; Reabilitação Oral.
... After excluding duplicates and screening the titles and abstracts, 10 papers were obtained for full-text assessment. Five papers [17][18][19]21,22] were included ( Figure 1); three papers [23][24][25] were excluded due to the lack of a control group and two [26,27] due to the publication of subsequent reports on the same subjects. ...
... Two studies were excluded due to the heterogeneity of the origin of infection ( Table 1). Table 1 shows the study design and characteristics of the included studies [17][18][19]21,22]. No RCTs were found in the database search; only five CCTs were selected. ...
... No RCTs were found in the database search; only five CCTs were selected. The origin of infection was a periodontal lesion in one study [21], a periapical lesion in three studies [17][18][19] and a periodontal and/or periapical lesion in one study [22]. The implant location was not limited in any of the studies. ...
Article
Objective: This review aimed to investigate the feasibility of immediate implant placement in infected extraction sockets. Material and methods: We performed electronic and manual searches up to March 2017 to obtain data from randomized controlled trials (RCTs) and nonrandomized controlled clinical trials (CCTs). Using a fixed-effects model to assess the difference in survival rate (primary outcome), we evaluated the risk difference for immediate implant placement in infected and non-infected sites. We estimated the weighted mean differences (WMDs) of the change in marginal bone loss (MBL), probing depth (PD), modified bleeding index (mBI), marginal gingival level (MGL) and width of keratinized gingiva (WKG) at baseline and latest follow-up. Results: In total, five studies (0 RCT, five CCTs) were included in the systematic review and three studies were included in the meta-analysis. The risk difference for immediate implant placement in an infected extraction socket compared with that in a non-infected socket was −0.02. WMDs for MBL, PD, mBI, MGL and WKG between the two groups were 0.32, 0.12, 0.07, −0.06, 0.20 and 0.51, respectively. No statistical differences were observed between the two groups, except for the change in WKG. Conclusions: Implants can be placed in infected extraction sockets after thorough socket debridement. For aesthetics, WKG should be considered when performing immediate implant placement in infected sites.
... The main inclusion criteria were patients with either edentulous jaws or jaws with teeth with a poor longterm prognosis treatment planned for extraction. The inclusion criteria were: age >18 years, total or partially edentulous in one or both jaws, adequate bone volume (divisions A, B, or C according to Misch classification of bone available) (15) and appropriate bone density (classes D1, D2, or D3 Misch) (16). Exclusion criteria were: severely immunocompromised patients with a high recurrence of opportunistic infections, tuberculosis, or malignancy, decompensated diabetes, severe malocclusion, severe parafunctions (bruxism), inadequate bone volume (Division D of Misch), inadequate bone density (density D4 Misch), disorders that contraindicate surgical procedures, lack of collaboration, lack of oral hygiene (plaque index higher than 1). ...
... According to the Infectious Disease Unit, Serological parameters (CD4 cell count, CD4/CD8 ratio and HIV RNA viral load) were assessed every 6 months. Each 6 months from implant placement, a dental hygienist performed oral hygiene procedures and clinical parameters regording (15). ...
... Intraoral digital radiographic assessments were made immediately after surgery and at each follow-up visit. Bone level measurements were performed on the mesial and distal aspect of each implant, using the implantabutment junction as a reference point (15). They were made perpendicular to the long axis of the implant with long cone parallel technique, using an occlusal custom template to measure the marginal bone level. ...
Article
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Aim The purpose of this study is to evaluate the success of implant prosthetic rehabilitation "All on four" in HIV positive patients. Materials and Methods HIV-positive patients under a strict medical control with edentulous mandible and/or maxilla, were enrolled for the present study. The "all on four" protocol was applied with immediate fixed rehabilitations. Marginal bone loss, implant and prosthetic failure, biological and mechanical complications, serological levels (CD4 cell count, CD4/CD8 ratio and HIV-RNA) were recorded at 6, 12 and 24-month follow-up. Results A total of 108 implant were placed in 21 patients, and 27 rehabilitations were delivered. Five implants were lost (survival rate = 95.37%). At the 24-months radiographic evaluation, perimplant crestal bone loss averaged 0.98 ± 0.21 mm for upright maxillary implants (n = 30 implants) and 0.87 ± 0.18 mm for tilted maxillary implants (n = 30 implants). In the mandible, a mean peri-implant crestal bone loss of 0.88 ± 0.32 mm for upright implants (n = 24) and 0.91 ± 0.30 mm for tilted implants (n = 24) was found. No statistically significant difference in the marginal bone loss between tilted and axially placed implants, and between jaws at 6, 12 and 24-month follow-up evaluation (P>0.05). Moreover, not statistically significant linear correlations were found between serological levels and marginal bone loss. Conclusions Within its limitations, the present study reported that the "all on four" protocol can be a suitable treatment option in immunocompromised but immunologically stable HIV positive patients.
... So the reductions in plaque indices were comparable for both implant and adjoining natural teeth. This was in similarity to the studies 12,13 where they observed reduction in the plaque indices, but it was opposite to the results obtained 14 where they observed an increase in plaque index over the period of time. ...
... In the present study, Gingival Index also improved over time which can be due to decreased plaque index. The results of this study were comparable to earlier studies 13,14 . ...
Article
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Background: The objective of the present study was to compare the biting force of delayed implant and adjoining teeth. A total of 30 implants were consecutively placed in the partially edentulous area of the mandible in the first molar area either right or left side. Patients were recalled after placement of the implant for the recording of Biting Force, Gingival Index, Plaque Index, and Probing Depth. The findings showed a significant improvement in mean values of periodontal clinical parameters and biting force over the period of time. The implant-supported prosthesis which was used to replace the missing mandibular first molar produced a greater biting force than the adjoining natural second premolar and comparable to the mandibular second molar. The gingival index and probing depth scores were higher in the area of the implant as compared to the adjoining natural teeth even with comparable plaque index scores for both the implant area and natural teeth.
... The implant-abutment connection is described as a critical area susceptible to bacterial contamination [48], tissue inflammation [49,50], mechanical stress [51], and bone loss [52]. An internal connection far from the bone tissues led to a lower risk of the contami- The implant-abutment connection is described as a critical area susceptible to bacterial contamination [48], tissue inflammation [49,50], mechanical stress [51], and bone loss [52]. ...
... The implant-abutment connection is described as a critical area susceptible to bacterial contamination [48], tissue inflammation [49,50], mechanical stress [51], and bone loss [52]. An internal connection far from the bone tissues led to a lower risk of the contami- The implant-abutment connection is described as a critical area susceptible to bacterial contamination [48], tissue inflammation [49,50], mechanical stress [51], and bone loss [52]. An internal connection far from the bone tissues led to a lower risk of the contamination of the implant inner portion and the decreased risk of connection screw loosening [53][54][55]. ...
Article
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The study reviewed the state of the art of the clinical use of a convergent-neck-designed Prama implant. This implant was introduced approximately 10 years ago and was characterized by a specific and unique convergent neck with a microtextured surface (UTM surface) and Zirconium Titanium (ZirTi) implant body surface. The neck design was developed to adopt the biologically oriented preparation technique (BOPT). A critical analysis of the published clinical studies and an evaluation of the adopted clinical protocols were performed. A total of forty-six articles were eligible to be reviewed. Only sixteen clinical studies reported clinical outcomes on Prama implants, and nine of these were selected having the longest follow-up from different research groups. The clinical follow-up/duration of the studies ranged from 12 months to 6 years. The initially proposed protocols explored neck supracrestal–transmucosal placement and gained interest due to its minimally invasive concept and the ability to proceed without a pre-prosthesis second surgery. The following investigations dedicated attention to the subcrestal or equicrestal implant placement with the conventional flap approach. The clinical studies characterized by the transmucosal exposed neck approach reported high survival rates with a stable bone morphology and reduced bone loss during the follow-up. Further recent implementations included the introduction of different convergent neck heights that need to be evaluated. The use of intraoral scanner technologies and digital workflow resulted in a simpler methodology with control of the marginal crown morphology. The studies support the concept that the hard tissue parameters (such as marginal bone level, MBL) and soft tissue parameters (such as pink esthetic score, PES) were stable or improved during the follow-up. Definitive crowns, designed with low invasiveness for soft tissues, were possible thanks to the morphology of the neck. The clinical studies support the use of the Prama implant with the different neck positions, demonstrating hard tissue preservation and optimal esthetic results in the first years following insertion. However, the current body of evidence is not robust enough to draw definitive conclusions, especially in the long term, and further high-quality research (long-term randomized trials) is required to consolidate these early observations.
... 1,2 However, it is argued that moderate infection without active suppuration is not a contraindication to immediate implant placement. 3,4 In addition, radiographic and histologic results have shown that an immediate implant placed in an infected site does not result in significantly different outcomes over placement in a noninfected site. 5,6 However, previous studies have reported some limitations. ...
... Evidence supporting the positive outcomes of immediate implant placement in infected extraction sockets has suggested that the results are unlikely to differ markedly from those of implants placed in noninfected extraction sockets. 4,18,19 The present study builds on previous studies using a more complicated model of infection, an endodonticperiodontic combined lesion model. Clinically, this complex pathology is relatively common. ...
Article
Purpose: To investigate the histologic differences between immediate implants placed in chronically infected sites and noninfected sites in a canine model. The histologic results of immediate implant placement also were evaluated on the basis of healing time and implant surface modification. Materials and methods: Chronic endodontic-periodontic combined lesions were induced on the second, third, and fourth premolars of the hemimandible in six dogs, with the contralateral teeth as controls. Implants were immediately placed following the infected and noninfected tooth extractions using implants with a machined surface, sandblasted with alumina and acid-etched surface, and chemically modified sandblasted with alumina and acid-etched with calcium solution surface. After 1 and 3 months, three dogs were euthanized and the bone-to-implant contact, bone area fraction occupied, buccal and lingual first bone-to-implant contact from the implant platform, and buccal and lingual marginal bone loss were calculated. Results: On histologic evaluation, no inflammation was observed around implants placed in the infected or noninfected sockets. At 1 month, no statistically significant differences were observed between the infected and noninfected sockets in buccal marginal bone loss in the machined implant group (P = .046), lingual first bone-to-implant contact from the implant in the sandblasted with alumina and acid-etched group (P = .046), lingual marginal bone loss in the sandblasted with alumina and acid-etched implant group (P = .028), buccal first bone-to-implant contact from the implant platform in the chemically modified sandblasted with alumina and acid-etched with calcium solution group (P = .028), and lingual first bone-to-implant contact from the implant platform in the chemically modified sandblasted with alumina and acid-etched with calcium solution group (P = .046). At 3 months, no statistically significant differences were observed in parameters between the infected and noninfected sockets for three implant surfaces. Differences between the infected and noninfected sockets were observed between the machined and sandblasted with alumina and acid-etched implant at 1 month (P = .023). Conclusion: Immediate implant placement in an infected socket did not lead to any differences when compared with placement in a noninfected socket when sufficient healing time was provided.
... Thus, Cafiero et al, 5 in a study of 82 immediate implants, did not include molars to be extracted for periodontal disease in their sample. However, other studies 22,23 have reported favorable results with implants placed in patients with periodontal disease. Crespi et al 22 placed and immediately loaded 275 implants in extraction sockets, 197 in periodontally infected sites and 78 in noninfected sites; after 48 months, survival rates of 98.9% and 100%, respectively, were achieved. ...
... However, other studies 22,23 have reported favorable results with implants placed in patients with periodontal disease. Crespi et al 22 placed and immediately loaded 275 implants in extraction sockets, 197 in periodontally infected sites and 78 in noninfected sites; after 48 months, survival rates of 98.9% and 100%, respectively, were achieved. Alves et al 23 placed 168 implants (108 immediate and 60 delayed) in 23 periodontally compromised patients; only two delayed implants did not osseointegrate, yielding an overall 3-year cumulative survival rate of 98.74% (100% for immediately placed implants). ...
... A study conducted by Roberto et al. found no significant differences between implants placed and immediately loaded in periodontally infected sockets compared to those placed in uninfected sites [29]. Further, Thomas et al. confirmed that immediate placement of implants into sites with periapical pathologies could be a successful treatment strategy, contingent on careful debridement of the extraction socket [30]. A series of cases presented by Simone et al. suggested that implant placement in infected fresh extraction sockets may yield predictable outcomes, provided adequate care is exercised pre-and post-surgery [11]. ...
Article
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A healthy 47-year-old woman consulted the Oral Surgery and Implantology Unit of the University Hospitals of Geneva with a request to treat her painful tooth 11 and replace the missing tooth 21. The dental history revealed that the patient had lost teeth 21 and 22 due to advanced caries. On clinical examination, tooth 11 showed an ill-fitting prosthetic crown with overhanging margins, an increased localized probing depth of 8 mm in the disto-vestibular area, and sensitivity to percussion. The edentulous site 21 showed horizontal bone atrophy. Radiological examination revealed a well-defined unilocular radiotransparent lesion surrounded by a thin radiolucent border, located at the apex of tooth 11 and measuring 10 × 8 mm. The treatment consisted of extraction of 11, enucleation of the apical lesion, and insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure, with aesthetic and functional results at 3-year follow-up without any complications. Our case highlights that immediate implant placement in cases of cystic periapical lesions represents a good valid alternative to standard treatment.
... In a retrospective study by Bell et al. [36] involving 922 implants, dental implants placed immediately into extraction sites with chronic periapical infections after curettage and irrigation of the periapical lesions had a success rate of 97.5%, while implants placed in sockets without signs of periapical infections exhibited a success rate of 98.7%, but the difference in success rates between the two groups was not statistically significant. Crespi et al. [37] conducted a prospective 4-year study to compare the outcomes of immediate loading of dental implants placed immediately in teeth extraction sites, with and without chronic periodontal lesions. Prior to dental implantation, antibiotic administration, meticulous cleaning, and alveolar debridement procedures were performed. ...
Article
Purpose: This study aimed to investigate whether new-onset periodontitis or apical periodontitis in the adjacent teeth affects osseointegrated dental implants in a beagle dog model. Methods: One control group and 2 experimental groups (periodontitis and apical periodontitis groups) were defined based on the presence of experimental periodontitis or apical periodontitis, with 1 beagle dog randomly assigned to each group. The mandibular second and fourth premolars on both sides of the 3 beagles were extracted. Eight weeks after extraction, 4 bone-level implant fixtures, 2 on both sides of each mandible, were placed in each beagle. Six weeks after implant surgery, healing abutments were connected. After sufficient osseointegration, plaque control was performed in the control group, while periodontitis and apical periodontitis were induced in the experimental groups. The beagles were euthanized for histological analyses 20 weeks after induction of experimental periodontitis. Statistical analyses were performed using the Kruskal-Wallis test with the Bonferroni correction to compare the 3 groups. Results: The implants in the control and apical periodontitis groups were well-maintained, while those in the periodontitis group showed clinical signs of inflammation with bone resorption. The bone-to-implant contact (BIC) and bone area values in the periodontitis group were lower than those in the other groups. The distance between the implant shoulder and the first BIC was significantly greater in the periodontitis group than in the control group (P<0.05). Conclusions: The presence of periodontitis in adjacent teeth can pose a risk to dental implants, potentially resulting in peri-implantitis. However, this was not observed for apical periodontitis. Within the limitations of this study, periodontal care is necessary to reduce the impact of periodontitis in adjacent teeth on osseointegrated implants.
... The placement of immediate post-extraction implants in periodontal infected sites is considered a controversial issue and many clinicians are reluctant to perform such treatments. Nevertheless, several authors have concluded that good results can be obtained in such situations, reducing the need to perform several surgical procedures (28,29). In the present sample, almost 30% of the patients had history of periodontitis and this variable was not associated with a higher risk of complications. ...
Article
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Background: Immediate loading of dental implants is considered an excellent option to reestablish function and aesthetics in a short period of time, thereby reducing the psychological impact of edentulism. The aim of this study was to describe the incidence of complications in immediately loaded implant-supported single or partial maxillary provisional rehabilitations; to assess changes in patient quality of life (QoL); to evaluate patient overall satisfaction; and to determine whether the occurrence of complications affects these outcomes. Material and methods: Patients requiring partial rehabilitation with implants in the maxilla were included in a prospective cohort study. In all cases, implant-based restoration with an immediate loading protocol was indicated. A provisional restoration was placed within 72 hours after implant placement. Patient QoL was measured at the first appointment and just before placing the final restoration, using two validated questionnaires. All mechanical and biological complications occurring up until placement of the final restoration were documented. A descriptive and bivariate analysis of the data was performed. Results: Thirty-five patients with 40 prostheses supported by 60 implants were analyzed. Three implant failures were observed, yielding a 95% survival rate. Five provisional prosthesis fractures and two prosthetic screw loosenings were recorded in four patients. A significant reduction in OHIP-14 score was observed. Likewise, significant differences were found in the results of the QoLFAST-10, with a mean difference in score of 7.3 between the initial and final evaluation. Conclusions: Patients receiving immediately loaded implant-supported single or partial maxillary provisional rehabilitations seem to have a low risk of developing early mechanical (13.3%) or biological complications (5%). These patients appear to experience significant improvement in QoL and report excellent overall satisfaction with the treatment received - though the occurrence of complications seems to affect these outcomes.
... This observation is validated by the fact that implant length was not significantly correlated with implant survival in Cox regression. In addition, the implants' survival rate for ISFCDs reconstructions in the current study corroborate with the values reported not only for standard tilted implants but also for standard implants placed in grafted areas (> 95%), all with similar bone level to those of standard implants placed via traditional methods over time [19,37,38], even when implants were placed in post extraction non-infected and infected sites [39,40]. Altogether, such data indicate that 3 extra-short implants are capable of supporting ISFCDs, and are a viable alternative to grafting procedures and tilted implants. ...
Article
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Objectives To evaluate the survival of implants and prostheses, and marginal bone level of fiber-reinforced composite implant supported fixed complete prostheses supported by 3 implants.Materials and methodsPatients with fiber-reinforced composite fixed prostheses supported by 3 standard-length, short or extra-short implants were included in this retrospective cohort study. Kaplan-Meier survival was computed for implants and prostheses. Univariate and multivariate Cox proportional hazard regressions, clustered by patient, were used to analyze bone level differences as a function of different study covariates. Linear regressions were used to investigate the relationship between distal extension lengths and bone levels.ResultsForty-five patients with 138 implants were followed for up to 10 years after prosthesis insertion (mean 52.8; SD 20.5 months). Kaplan-Meier survival analysis showed overall survival rates of 96.5% for implants and of 97.8% for prostheses. The 10-year success rate for prostheses was 90.8%. Extra-short implants survived at similar rates to short and standard implants. Marginal bone levels surrounding implants remained stable over time, even showing slight bone gain on average (mean + 0.1 mm/year; SD ± 0.5 mm/year) Acrylic denture teeth, overdentures on the opposing arch, and implant placement in the posterior maxilla were correlated with bone gain. Screw retention, opposed to telescopic retention, was correlated with bone loss. Longer distal extensions were correlated with bone gain on the implants closest to the distal extensions.Conclusions Fiber-reinforced composite fixed prostheses supported by only 3 implants, most of which were extra-short, presented high survival rates with stable bone levels.Clinical relevanceAn encouraging prognosis can be expected for restoration of atrophic maxillary and mandibular arches, when restored with fixed fiber-reinforced composite frameworks with long distal extensions and supported on only 3 short implants.
... The exclusion criteria were general contraindications to implant surgery, radiotherapy in the head or neck area, chemotherapy for malignancy in the previous 5 years, uncontrolled diabetes, severe psychiatric disease, patients taking intravenous bisphosphonates, smoker of more than 9 cigarettes a day, pregnant or lactating women, severe parafunctional activity, vertical root fracture including the facial root or horizontal fracture apical to facial bone crest, mobility of grade two or more, moderate or severe periodontitis with more than three millimeters attachment loss, ankylosed tooth, class II or III extraction sockets, and not attending the follow-up appointments. In addition, acute infection or fistula in the site planned for implant insertion was an exclusion criterion; however, chronically infected sockets [29] with small periapical lesions that comprise less than one-third of the root length were eligible to be included in the study. ...
Article
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Background The aims of this case series were to investigate the clinical, radiographic, implant success, complication incidence, esthetic, and patient-reported outcomes of 10 immediately placed implants associated with the socket shield technique at 12 months post-loading and to assess the ridge width changes that occurred at 8 months following implant placement. Methods A total of 10 patients received 10 socket shield immediate implants (MegaGen AnyRidge). At 8 months postimplantation, casts were made to assess the ridge width changes by measuring the ridge width at the implant sites and comparing them with the corresponding measurements at the contralateral tooth site. At 12 months post-loading, clinical indices, marginal bone loss, pink esthetic score, and patient-assessed outcomes were evaluated. The mean, standard deviation and median were calculated for all continuous variables. Results All implants demonstrated a 100% success rate, while 2 implants presented with external shield exposure that was managed successfully. The mean marginal bone loss was 0.08 ± 0.14 mm mesially and 0.21 ± 0.23 mm distally. Esthetic evaluation yielded an average modified pink esthetic score of 8.65. A mean gain of 0.17 mm in the facial-palatal ridge width was recorded at 8 months postimplantation. Conclusions The socket shield technique enhanced the functional and esthetic results by preserving the alveolar bone and peri-implant soft tissues. However, this is a sensitive technique and still needs more robust evidence before it can be recommended for everyday clinical practice.
... Therefore, the use of magnification and thorough rinsing are important ancillary steps to achieve proper cleaning, which is a factor influencing success during implantation in infected sockets. 32 The study by Crespi et el 33 confirms that immediate implantation in infected sockets after debridement with limited access showed no significant difference in marginal bone loss, Bleeding Index, and plaque accumulation after 48 months compared with implantations in uninfected sites. Moreover, a recent systematic review showed similar results for periimplant bone loss but reported a higher risk of implant failure for infected sites. ...
Article
Purpose: Comprehensive rehabilitation in patients with severe periodontal destruction may require the use of dental implants. The primary aim of this study was to evaluate bone volume changes in periodontally compromised patients over a 12-month follow-up period after immediate full-arch implant reconstruction of the mandible. The secondary aim was to evaluate the repeatability of 3D bone volume change measurement methods around dental implants. The null hypothesis was that bone volume would decrease in the first year after delivery of the definitive prosthetic reconstruction. Materials and methods: This retrospective study analyzed CBCT scans of 16 patients before and after computer-guided immediate full-arch implant reconstruction of the mandible. The bone volume change in the mandibular body and around the implants and the peri-implant bone area in coronal and axial cross sections were calculated. Results: The average bone gain for the mandibular body was 3.3% ± 1.8%. The average bone volume increase in the peri-implant area was 23.2% ± 16.7%. The interobserver and intraobserver ICC values for 3D measurements were high (> 0.85). Conclusion: The null hypothesis was rejected. Both mandibular body and peri-implant surroundings undergo bone remodeling in the form of bone gain over 12 months after immediate implantation.
... Immediate implant placement is a highly predictable protocol that reduces treatment plan, which patients appreciate, gives esthetic results while maintaining soft and hard tissue and these results are carried over time. Literature has shown a survival rate of 96.23% after 5 years in immediate implants placed in sites with periapical lesions [21,22]. This protocol can be successfully and predictably applied in infected teeth or with apical lesions as long as a series of requirements are meet. ...
Article
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Currently, our patients come to our consultations with knowledge of oral implantology requesting immediate resolution protocols, having us as clinics to apply more advanced technologies where diagnosis plays a determining role. The appearance of periapical lesions until some time ago meant an inconvenience in the development of these treatment plans, having to delay for 3-6 months the completion of the case. The study, development and benign behavior of this type of search is quite clear in the literature, demonstrating over time the importance of a timely diagnosis and an effective surgical technique for its resolution. There are many consensuses described in the literature on immediate implementation, but it is necessary to make case reports with clinical and radiographic follow-up where the management and application of minimally invasive surgical techniques that allow extraction, cyst enucleation, bone curettage, can be shown. guided bone regeneration and finally immediate implantation, definitively shortening the treatment time and increasing the regenerative potential of our jaws and therefore the satisfaction of our patients.
... A more recent research salivary flow rate and pH of periodontal patients with associated cardiovascular disease concluded that decrease in salivary pH and flow rate was significantly associated with severity of periodontal disease [21]. The present study protocol can also be used in patients getting the rehabilitation with implants as well [22][23][24][25][26][27]. Titanium creates an extremely shielding oxide film on the surface, and it becomes passive. ...
Article
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Periodontitis is an infectious illness which leads to the inflammation of protective tissues around the teeth and the continuous loss of alveolar bone and conjunctive tissue. Biomarker analysis in serum and saliva helps in the evaluation of disease progression and activity. It is also established that every inflammatory change along with resultant damage of tissues ends up in altered pH values in the fluids and tissues. Aim: To correlate the connection of pH levels in both blood as well as saliva in healthy, periodontitis, and gingivitis patients. Materials and methods: The current research involved 145 subjects amidst the age of 20 and 55 years. The subjects were split into three different groups: healthy (Group A), gingivitis (Group B), and finally chronic periodontitis (Group C). The recording of clinical parameters was done by gingival index (GI), probing depth (PD), and plaque index (PI). pH of saliva and blood was analyzed with the help of digital single electrode pH meter. Subjects have gone through scaling and root planning (SRP) coupled with the instructions of oral hygiene. They were recalled post 4 weeks, and saliva and blood samples were gathered for analyzing pH. Results: Clinical parameters GI and PI were statistically important in both group C as well as group B post SRP. A crucial change has been observed in attachment levels (AL) and PD in the case of periodontitis group post SRP. The difference in the salivary pH values were significant between group B vs. C and A vs. C before the treatment because the values for group C were acidic, whereas in groups B and A the pH was alkaline. After the treatment, the values were still significant because the pH has become more alkaline compared to preoperative value in both group B and C. Saliva's pH levels have demonstrated a statistically significant reduction in group C post SRP. Conclusion: Salivary pH levels and blood evidently became alkaline in the group C patients post SRP and there is a positive correlation between them and the clinical parameters.
... Subjecting patients to a monitoring protocol and professional oral hygiene sessions could be the key to the success of fixed prosthetic restorations, both on natural teeth and on implants (14). During professional oral hygiene sessions, the use of specific clinical parameters and devices customized according to the type of rehabilitation, could reduce risk of prosthetic failure (39)(40)(41). Clinical parameters as Plaque Index and Bleeding Index, could allow both to early identify the accumulation of bacteria potentially harmful to the periodontium in natural teeth and in the peri-implant area, and to intercept possible inflammatory state of evaluated sites (42,43). ...
Article
The aim of this retrospective clinical study was to evaluate and compare oral hygiene levels in patients subjected to fixed metal-ceramic or stratified zirconia prostheses, either on teeth or on dental implants. Twenty patients, including 10 with metal-ceramic prostheses and 10 with stratified zirconia, were engaged for the study. Considering the prosthesis positioning phase as zero time, all patients were examined twice a year for a follow-up period of 3 years. During each session, to assess oral cavity state of health, both the Plaque Index (IP) and the Bleeding Index (BOP) were recorded. All patients were instructed in home hygiene maintenance and subjected to professional oral hygiene sessions customized according to prothesis type (on natural teeth or dental implants) and materials (metal ceramic or stratified zirconia). Statistically significant evidence was found in IP values, with an increase in the initial stages in zirconia prostheses and in the final stages in metal-ceramic ones. BOP levels showed a reduction during the follow-up period, but no statistically significant differences were found between examined groups. An adequate patient education in hygiene maintenance associated with professional oral hygiene sessions with special tools could positively affect fixed prostheses' maintenance, both on natural teeth and on dental implants.
... time (10)(11)(12). In addition, virtual aesthetic planning systems represent a powerful, communicative, and motivational tool for patients, having the potential to actively involve them in the rehabilitation process, also facilitating acceptance and compliance with the treatment plan (6). ...
Article
The aim of this clinical study is to present an integrated digital project through the description of a clinical case, made entirely in digitized form, taking advantage of the opportunity offered by instrumental diagnostic software. A case report participant is a 65-year-old female patient presents with loss of diffuse bone support, caused by periodontal disease. After a sign of an informed consent and an explication of a plan of treatment, technical intraoral and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Smile Lynx Software and the scanner stereolithographic (STL) file was matched into the CAD Lynx to obtain a virtual previsualization of teeth and smile design, and to mill the provisional and the definitive crowns. The digital prosthetic design allows the evaluation of the dental parameters in relation to the parameters of the patient's face for the new prosthetic project and the radiological examination using CBCT guides the insertion of the fixtures for the rehabilitation phase. The surgical and prosthetic design are subsequently integrated. The evaluation of the bone bases is carried out with a radiological diagnostic software for CT (Real Guide 5.0-3Diemme, Cantù-Italy) which can virtually design the implant insertion. The functional examination of the patient is carried out through an occlusion-postural examination that uses digital electromyographic assessments. The integrated digital protocol proposal inserts in the rehabilitation path the digital recording of the free mandibular movement, as well as the scan of the patient's face, data that will be integrated into the CAD software for the design of temporary and definitive prosthetic artifacts, made using the CAM method. This study showed guided implant placement and the application of fixed implant-supported prosthetic restorations carried out with a fully digital workflow, dependent on the functional digital evaluation of the patient's occlusion. The proposed protocol described the correct use of digitalization of clinical, surgical, and prosthetic procedures, and the matching of the data into a computerized environment, to improve team communication and to take advantage of the combination of collected data to not lose information using classic manual steps.
... In the clinical case described, the All-on-4 technique was used as a rehabilitation choice, the effectiveness of which has already been confirmed by a considerable number of previous studies. This does not exclude the possibility of applying this protocol also in other types of simple and complex implant restorations (38)(39)(40). ...
Article
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The aim of this article is to describe how, during the provisional and definitive prosthetic phases, using new digital technologies, it is possible to improve the ergonomics of the prosthetist's work and reduce the discomfort of patients, subjecting them to the fewest possible appointments at the dentist. The proposal of a full digital protocol, described by the following case report, for the realization of a definitive prosthetic rehabilitation supported by a reduced number of implants, in fact, allows to considerably reduce the number of appointments and reduce any bias. A 67-year-old male patient presents for the first visit to the Department of Dentistry of the San Raffaele Hospital, wearing a removable upper prosthesis and with the request to heal the aesthetic and functional situation through prosthetics fixed. An initial panoramic radiograph was performed, intra and extra oral photos were taken and also intraoral impressions. A stereo-lithographic models are obtained from intraoral scans, and two total prostheses, upper and lower, were packaged for the provisional post-surgical phase was performed. In accordance with the All-on-4 method 8 implant fixtures were placed. For the final prosthetic phase, the patient underwent only two operative sessions. In the first session, scans were taken with the provisionals in situ, of the patient's mucous membranes and with the Scan-abutments in place. In the second session using specific CADSoftware the matching of the STL files of the three scans were created, the opposing arches of the patient were related on a digital articulator, and the milled titanium bars were immediately constructed and finished with the resin. Finally, the definitive prostheses were delivered to the patient without any other test. Digital technology has allowed a clear reduction in working times and costs and has allowed the reduction of stress for patients who undergo invasive and extensive treatments to recover aesthetics and function, and for clinicians who must manage complex cases with fewer appointments possible.
... The results of the analysis of the suPAR concentration in patients with dental restorations, that reveal association of the protein level with intensification of inflammatory process in patients using acrylic dentures over 5 years and who have pathological lesions in the oral cavity, are also promising [32]. Therefore, it may be interesting to evaluate suPAR levels in other aspects of dentistry such as dental implant treatment [33], biomaterials appliocation [34][35][36] and immunocompromised patient therapy [37,38]. ...
Article
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Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and reflects a more distinct aspect of inflammation than C-reactive protein (CRP) does. The study concerns a clinically silent state of the immune system expressed by the level of suPAR, which could affect the occurrence of complications (non-life threatening) after scheduled procedures. The purpose was the evaluation of suPAR predictive value in minor maxillofacial surgery complication incidents. Eighty patients were tested for suPAR, CRP and a series of basic laboratory serum tests on 1 day before surgery. Complications of orthognathic and minor injuries treatments were reported. The suPAR level, expressed as a measure independent of the patient’s age (Index of Body Inflammation, IBI), was analyzed. The protein level was also assessed on postoperative day 3. Basic statistical analysis did not reveal any relevant dependence between suPAR (or IBI) and occurrence of minor complications. The application of factor analysis, artificial neural network and inclusion of chlorides, glycaemia, alanine transaminase (ALT), albumin and hemoglobin levels allowed to indicate the suPAR/IBI ranges associated with an increased risk of minor postoperative complications. Concluding, it seems that, in the current state of the knowledge, the monitoring of pre-operational suPAR level solely does not include sufficient predictive information for the occurrence of minor complications after maxillofacial surgery. The suPAR/IBI level should be combined with other patient characteristics to predict healing complications.
... Hence, our case series demonstrates that immediate implant placement in infected extraction sockets can be successful, provided that thorough protocol is followed. [1,18] However, more randomized controlled clinical trials with a longer follow-up are required to confirm this procedure as a safe treatment. With the trend of shortening treatment time and reducing patient discomfort/inconvenience, immediate loading implant has reemerged as an alternate strategy and has shown promising and predictable results. ...
Article
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Conventionally, before placing dental implants, the compromised teeth are removed, and the extraction sockets are left to heal for several months. However, in the recent past, to preserve the alveolar bone level from collapsing and to reduce treatment time and procedures, tooth extraction is followed by implant placement immediately without waiting for the site to heal. The situation becomes critical with the presence of periapical pathology as it may cause failure of implant due to the presence of remnants of infection. This case series shows the survival of immediate implants placed in postextraction‑infected sites and restored with cemented crowns.
... 11,12 Nevertheless, several studies report high success rate for immediately placed and, in some cases, for immediately loaded implants in infected or inflamed postextraction sites. [13][14][15][16][17] Measures to decrease the bacterial load of infected sites include meticulous cleaning, alveolar debridement, the administrations of antibiotics, and postoperative Chlorhexidine 0.12% mouth rinses. [18][19][20] Assuming these clinical procedures and socket decontamination techniques are employed, the presence of an infection or periradicular, periapical, endodontic, or carious lesions appears not to compromise implant survival rate. ...
Article
Objective: The study aims to evaluate the feasibility of erbium-chromium: yttrium-scandium-gallium-garnet (ErCr:YSGG 2780 nm) laser irradiation on infected and/or inflamed post-extraction sites for the immediate placement, and when possible, immediate loading, of endosseous implants. Background: Post-extraction site infection is a serious complication. Surgical and nonsurgical options are available to treat such event, together with various decontamination methods. However, there is still no consensus on which treatment is the most effective. Materials and methods: Sixty-six patients were included in the study for a total of 94 post-extraction implants, inserted in the maxilla and mandible. All patients were eligible for implant therapy, having at least one compromised tooth requiring extraction, along with sign of inflammation and/or infection. Surgery and socket decontamination were performed using an ErCr:YSGG laser. To improve bone healing, Bio-Oss® and resorbable membrane were used in 57 patients. Eleven implants were immediately loaded, whereas 83 were loaded within 3-6 months, depending on the extraction site. Intraoral radiographs were taken at 1, 3, 6, 9, and 12 months from the implant placement to assess the alveolar bone level and treatment's outcome. Albrektsson criteria were chosen to evaluate the treatment success rate. Results: Follow-up went from 6 months to 4 years. Success rate was 94.6% (89/94): three implants failed to integrate due to poor patient compliance, being expelled during the second week, whereas two implants presented factory defects (abutment). No sockets presented signs of residual infection during follow-up. Conclusions: The combination of mechanical, chemical, and laser treatment was proven to be highly effective for the disinfection of post-extraction sites. The ErCr:YSGG laser is a useful tool, not only for his practicality as a surgical device but also as a disinfection tool, granting optimal results after implant surgery.
... Although classic studies showed increased implant failure when placed in infected sites, more recent studies demonstrate high survival over the long term with enhanced implant surfaces. [49][50][51] Aggressively curetting the socket to remove all chronic inflammatory or granulation tissue, chlorhexidine rinses, and antibiotic therapy, are all strategies to improve implant survival rate in these immediate cases. ...
Article
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Bone augmentation is an extremely common procedure in implant dentistry today because of significant advancements with reactive biomaterials, a better understanding of the mechanism of action that is found with growth factors contained in platelets, and improvements in surgical techniques. The expectation is for the surgeon to place the dental implant in the position that best serves the requirements of the prosthetic restorations. With the increasing demands that patients have for ideal prosthetic results, surgeons are expected to predictably augment both hard and soft tissues to provide the anticipated esthetic and functional outcomes. Bone grafting can be performed before, during, and after the implant placement; however, these augmentation procedures come with increased cost, the risk of complications such as infection or failure, and lengthening of the total treatment time. In addition, a plethora of grafting materials are available commercially, where they are often inadequately studied, or there is minimal information regarding their predictability or long‐term success, or ability to support dental implants. It is clear that although the surgical field has seen major progress since early implant surgical techniques in the 1980s, major challenges still exist with hard tissue augmentation procedures. This review will discuss these challenges that are increased and often specific to bone graft healing, and which are becoming more common as implant site development often requires bone augmentation to improve volume or contour deficiencies. The risk factors that patients may present with that will affect outcomes with bone augmentation procedures are identified, and recommendations for the prevention of complications or managing complications once they have occurred are provided.
... The literature lacks controlled clinical studies to determine the best option for the treatment of compromised postextraction sockets. Most studies 14,15 present favorable results from IIPP procedures performed in intact sockets but question its predictability when a facial bone defect is present or occurs during surgery. In a clinical scenario, most failing teeth in the anterior region may present a bone defect or a thin facial wall that may be resorbed after tooth extraction. ...
Article
Full-text available
This study evaluated the impact of soft tissue grafts to reduce marginal peri-implant recession (MPR) after 1 year of follow-up. A total of 24 patients with one single failing maxillary incisor presenting facial bone dehiscence and receiving an immediate implant, bone graft, and provisional were randomly divided into three groups (n = 8 in each group): control (CTL), collagen matrix (CM), and connective tissue graft (CTG). Clinical, photographic, and tomographic analyses were performed to evaluate tissue alterations. The use of a CTG avoided MPR (P < .05) and provided better contour of the alveolar ridge (P < .01) and greater thickness (P < .05) of the soft tissue at the implant facial aspect.
... Immediate implant insertion is an excellent alternative to substitute teeth indicated for extraction. 1 Previous studies showed that immediate implants placed on alveolar bone compromised by periapical diseases have similar success rates in comparison to immediate implants placed on healthy alveolar bone. [1][2][3][4][5] In cases of chronically infected apical alveolar bone, a severe curettage of the lesion followed by chemical cleaning of the alveolar bone is necessary, as otherwise there is risk of retrograde peri-implantitis. 2,6-8 A relevant number of reports of infected implants in chronically infected apical alveolar bone have been observed in literature. ...
... The plaque index (PI O'Leary), the presence of bleeding on probing (BOP) and of probing pockets depth (PPD) were recorded on teeth, whereas modified plaque index (mPI) and modified bleeding index (mBOP) referred to implants. 23,24 Each measurement was acquired at mesial, distal, palatal and vestibular sites. 25 Data were considered from the first maintenance visit, at 4 months from prosthetic functionalization of implants to the end of the followups. ...
Article
Objective: This study evaluated the strength of the association between three widely used clinical indexes considered as distal behavioural indicators of attitude-related oral status (an index of oral hygiene, the plaque index [PI] and two periodontal indexes, that is the presence of bleeding on probing [BOP] and of pockets probing depth [PPD]) and secondary implant failure due to peri-implantitis in patients rehabilitated with cemented prosthesis. Materials and methods: The study included patients who underwent implant-prosthetic rehabilitation and had joined the programme of maintenance of the same hospital. Implant failures, number of months between implant insertion and implant loading, and patients' surgical protocol were monitored and recorded. Further, PI, BOP and PPD-all attitude-related indicators of oral hygiene and periodontal inflammation-were recorded and related, in terms of odds ratios (ORs ) and corresponding risk factors, to secondary implant failures. Results: A total of 1427 patients (2673 implants) were enrolled. The follow-up ranged from 1.5 to 9 years (mean 5.3 years±1.3). The cumulative survival rate was 98.01%. Thirty-two patients (36 implants, 1.36% of all implants) had implant failure. A statistically significant association between PI, BOP, PPD and secondary failures due to peri-implantitis was observed. Conclusion: Within the limitations of this study, all three attitude-related behavioural indicators-the plaque index (PI), bleeding on probing (BOP) and abnormal probing pocket depth (PPD)-proved to be significant risk indicators for secondary implant failure due to peri-implantitis, both from a clinical and from a socio-psychological attitude-related perspective.
... [28,29] Contrary to these findings, several published studies in both animal jaws, long bone, and human trials have shown that periodontal or periapical lesions did not affect the ability for implants to predictably osseointegrate. [23,[31][32][33][34][35] Siegenthaler et al. [33] treated 17 patients consecutively who had periapical lesions using immediately placed roughened surface implants observed for 12 months with a success rate of 100%. The authors concluded that a critical aspect of treatment was to assess the diameter of the periapical lesion. ...
... No pain, suppuration or mucositis was present around any surviving implant and mean bone loss was not significantly different between the healthy (0.78mm) and the infected (0.79mm) groups. [31] On the other hand, Novaes Jr. and Novaes stated that the placement of immediate implants in chronically infected sites may not be necessarily contraindicated if appropriate clinical procedures like antibiotic administration, meticulous cleaning, and alveolar debridement are performed before implant surgical procedure. recently, [10,22] . ...
Article
Full-text available
Dental implants can be placed immediately into healthy extraction sites with high success and survival rates. It has been suggested, however, that immediate placement of implants into infected extraction sites is contraindicated due to the pathology interfering with osseointegration resulting in decreased implant survival and success With many potential implant sites presenting with a preexisting periapical or periodontal infection, treatment protocols have been advocated for immediate placement of implants in these infected sites. Advancements in surgical techniques and implant surface technology have made immediate placement of implants a more predictable and accepted treatment option; however, there is still debate about whether infected extraction sites should be used for immediate implant treatment approaches. The purpose of this clinical update is to report on the success and survival of implants placed immediately into infected extraction sites.
Article
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Background: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). Methods: The PICO strategy was used to formulate the hypothesis under study: "For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?" The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. Results: Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I 2 = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results (p = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I 2 = 45%), with no significant differences between studies (p = 0.91). Homogeneous results (I 2 = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant (p < 0.00001) for this parameter. Conclusions: Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).
Article
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Objectives The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone. Materials and Methods An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias‐corrected and study size‐weighed bootstrap tests. A study time‐correcting meta‐analysis was then performed to obtain an overall effect for the study pool. Results A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow‐up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of −1.9 percentage points [PP], 95% CI: [−0.3, −4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004). Conclusions Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments.
Article
Introduction: The present study aims to assess and compare the clinical outcomes of immediate implant placement in the mandibular molar region with or without the presence of chronic periapical periodontitis. Materials and methods: Employing a case-control design, this study encompassed a cohort of patients necessitating implant surgery to supplant a single, failed mandibular molar. Participants exhibiting periapical lesions measuring between > 4 mm and < 8 mm were assigned to the test group, while those without periapical lesions to the control group. Subsequent to flap surgery and tooth extraction, extraction sockets were debrided thoroughly, and implants were immediately implanted (baseline). Permanent restorative procedures were carried out three months post-operation, with follow-up conducted one year post-surgery. During the study period, parameters including implant survival rate, Cone Beam Computer Tomography (CBCT) data, implant stability quotient (ISQ), insertional torque values (ITV), and potential complications were closely monitored. Results: Throughout the year-long observation period subsequent to implant placement, both groups exhibited a 100% implant survival rate. None of the participants experienced any complications. Both groups demonstrated significant decreases in the height and width of the alveolar bone (P < 0.05). However, there were no statistically discernible differences between corresponding areas in the two groups (P > 0.05). The differences in ITV between the test group (37.94 ± 2.12 N•cm) and the control group (38.55 ± 2.71 N•cm) were not statistically significant at baseline (P > 0.05). A significant rise in ISQ was noted within the same group between baseline and three months post-operation (P < 0.05), while no significant variations in ISQ changes were noted between the two groups (P > 0.05). Conclusion: Given the constraints of this investigation, the preliminary clinical outcomes of immediate implant placement in the mandibular molar region with chronic periapical periodontitis do not significantly differ from those observed in instances devoid of chronic periapical periodontitis.
Article
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bjective This study aimed to investigate the effect of immediate versus delayed dental implant placement strategies on cell differentiation in a dental callus. Design The implant was placed in the mandible with two nearby teeth using an idealized two-dimensional finite element model. Eight weeks after surgery, the mechanobiological modeling of healing was used to estimate cell differentiation. It was assumed that the callus was initially filled by mesenchymal cells. The model then transformed mechanical stimuli received by the callus from loadings in terms of distorsional and dilatational strains into predictions of the cellular phenotypes, including fibroblasts, chondrocytes, and osteoblasts, or whether they would remain unchanged or die. Results The results demonstrated that delayed loading led to greater bone formation than immediate loading. Osteoblast colonies were observed in the base of threads in the immediately-loaded implant, whereas the delayed loading caused distant bone formation from the surrounding bone side towards the implant. The osteoblasts were differentiated from both intramembranous and endochondral mechanisms of ossification. After eight weeks, approximately 61% of the callus was ossified in the delayed placement model compared to 35% in the immediate placement model, resulting in a greater amount of fibrocartilaginous tissue on the bone side of the callus. Conclusions Immediate and delayed loading models generated different results. In the delayed strategy, bone cells were supplied appropriately during the first few weeks following surgery, whereas the immediate loading caused fibrocartilaginous tissue differentiation. In the form of distant osseointegration, the secondary stability of the dental implant was higher and faster due to the delayed placement.
Article
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Aims: There is a controversy regarding the indication of implant insertion into the sockets of infected teeth. This study aimed to evaluate the outcome of immediate implants replacing periapically infected teeth utilizing Resonance Frequency Analysis (RFA) method. Materials and Methods: Preoperatively, clinical, and radiographic examination accomplished for the patients. After anesthetizing the surgical area, the accused tooth extracted, and the socket curetted by surgical curette to remove the periapical lesion then irrigated by normal saline solution. The implant inserted into its prepared site. Beta-tricalcium phosphate (β-TCP) (combined by collagen membrane) used to fill gaps ≥ 2 mm and to repair bone defects. Implant stability quotient (ISQ) values were measured for the implants during surgery and after 16 weeks. Postoperative clinical and radiographic evaluation were conducted for each patient. Results: Fourteen implants out of 41 immediate implants (34.1%) had been inserted in the extraction sockets of teeth have chronic periapical lesions (infected sites), T-test showed no significant difference in implant stability (ISQ value) between implant placed in infected and non-infected sites neither at baseline nor at 16-weeks. Paired t-test showed highly significant increase in implant stability (ISQ value) of implants placed in infected sites while in the other implants the mean ISQ value increased with no significant difference during the healing period. The success rate was 100% after 4 years of implantation. Conclusions: Presence of periapical lesion is not a contraindication to place immediate implant when properly managed and can provide similar survival rate to that of implants inserted into healthy sockets.
Article
Statement of problem Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. Purpose The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets. Material and methods An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference). Results In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters. Conclusions Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.
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We feel very humble to share our notes in Implant Dentistry to the dental communities, we hope our little works could be beneficial to other colleagues for their clinical works and studies. Please feel free to leave us comments, and this project is a continuous progress, at the end, we hope everyone in the communities to update the notes, and may inspire colleagues from other disciplines doing something similar.
Thesis
L'implantologie orale, grâce à son développement depuis plusieurs années, fait désormais partie intégrante de nos plans de traitement. Le taux de succès élevé des traitements implantaires en fait une thérapeutique qui peut être considérée comme fiable. La discipline reste néanmoins exigeante. Des conditions optimales et un protocole implantaire rigoureux sont obligatoires. Par conséquent, plusieurs interrogations se posent dans les cas où le site receveur présente une lésion endoosseuse d'origine endodontique. Dans cette situation, l'attitude clinique peut être difficile à déterminer. Le but de ce travail est d'évaluer les implications de ces lésions en implantologie, et de définir ensuite la conduite à tenir dans ces situations. Après avoir procédé à une analyse de la littérature, les résultats seront discutés afin de répondre aux questions suivantes : Quelles sont les limites imposées par les lésions endo-osseuses en implantologie ? Comment gérer le site implantaire et lutter contre l'infection?
Article
Statement of problem: Immediate implantation has been established to shorten waiting time before definitive restoration, offering the ability to deliver a predictable esthetic and functional outcome for patients. However, this approach remains controversial for a tooth with a periodontal or periapical lesion. Purpose: The purpose of this systematic review was to analyze the treatment outcomes of immediate implant placement into extraction sockets with or without infection of periodontal or periapical origin in the esthetic zone and to provide treatment protocols based on current studies. Material and methods: An electronic search was performed in PubMed, ISI Web of Knowledge, and the Cochrane Library between January 2009 and October 2017. A subsequent manual search included all clinical studies published in the English language and excluded any reviews or animal studies. An article quality assessment scale, Newcastle-Ottawa Scale (NOS), was used to evaluate the quality of studies enrolled. The implant survival rate was expressed as risk ratio, whereas bone level changes and gingiva level changes were expressed as mean differences in millimeters with 95% confidence intervals. The meta-analysis was conducted by using commercial software. Results: The search initially found 1171 references. The manual search of the reference lists of identified articles yielded additional papers. Altogether, 9 studies were identified within the selection criteria, with NOS scores between 5 and 8. Compared with the healthy sites, immediate implant placement in infected sites in the esthetic zone showed similar survival rates (97.6% vs. 98.4%, respectively; risk ratio [RR], 0.99; 95% confidence interval [CI], 0.97 to 1.00; P=.138). No statistically significant differences were found in bone level changes (mean difference [MD], 0.03; 95%CI, -0.09 to 0.14; P=.667) or in gingiva level changes (MD, -0.06; 95% CI, -0.13 to 0.01; P=.070) between the 2 groups. Conclusions: Meta-analysis showed that immediate implant placement into infected sites and noninfected sites in esthetic zone had similar survival rates, bone level changes, and gingiva level changes.
Article
Patient expectations from implant treatment have changed over the years and esthetics plays an important role in defining what is now called success of rehabilitation. Of the many factors that influence the outcome of the rehabilitation, the two main ones are the bone and soft‐tissue deficiencies at the intended implant site. Many surgical approaches are described in terms of timing of implant placement and management of regenerative procedures. The aim of this article is to discuss the different implant placement alternatives in the esthetic area, in particular: (i) the timing of implant placement/regenerative procedures/skeletal growth/altered passive eruption; (ii) the correct three‐dimensional position of the fixture between the cuspids and in the premolar area; (iii) multiple missing teeth in the esthetic area with single tooth/pontic or cantilevered options/prosthetic compensation; (iv) placement of implants into infected sites; and (v) the influence of abutment and crown morphology on implant position. Combining our long‐standing clinical experience and the pertinent literature, the following conclusions can be drawn: • Immediate implant placement can be a successful procedure in terms of esthetics but it is technique sensitive and requires an experienced team. • Immediate placement is less traumatic to the patient as fewer surgical procedures are involved and patients tend to prefer this clinical approach with regards to quality of life. • The diagnostic phase is of utmost importance, with not only bone and soft tissue deficiencies being addressed but also: skeletal growth, dental/implant soft tissue parameters such as altered passive eruption and the morphology of the roots adjacent to the edentulous area. • Post‐extraction immediate loading is feasible in infected sites. • The correct position of the fixture should follow widely accepted guidelines but the abutment morphologies play a role in the vestibular/palatal position of the implant. • The long axis of the implant, aiming at the incisal edge of the future restorations, is the most appropriate implant position when a shoulder‐less abutment is used and allows a restorative crown morphology with a cervical contour resembling a natural tooth. • The use of a shoulder‐less abutment gives more space for the tissue to grow compared with the traditional abutment with shoulder finish line.
Article
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The rehabilitation of partially or totally edentulous patients with implant-supported prostheses has become routine, with excellent long-term outcome. A proper implant position is mandatory to achieve good functional and esthetic outcome and may require an adequate amount of alveolar bone and surrounding soft tissue. When this is lacking because of atrophy, sequelae of periodontal disease, traumas or congenital malformations, increased bone volume and/or keratinized mucosa can be obtained by guided bone regeneration, bone-grafting techniques and alveolar bone expansion. This article presents an evidence-based, prosthetically driven approach for the treatment of edentulous ridges with horizontal defects. The classification of bony defects, the main augmentation techniques, the selection criteria among different surgical procedures for different types of bony defects, and the advantages, disadvantages and limitations of each technique, are described in detail.
Article
Dental implants are a mainstream treatment protocol to replace missing teeth. Patient and clinician demands have led to shorter length and narrower diameter implants, immediately placed implants into infected sites, and the use of implants in children. This article reviews some of the controversial topics in implant dentistry, and presents the evidence that supports and challenges these newer techniques. Because long-term studies are often not available, especially for implants in infected sites, mini implants, and implants in the growing patient, the field continues to evolve.
Article
Purpose: The aim of this study was to assess whether immediate implant placement into post-extraction sites presenting a chronic infection poses a greater risk of implant failure than immediate placement in non-infected sites. Materials and methods: Records of patients who underwent extraction and immediate implant placement into both infected and non-infected sites from January 1998 to September 2014 at 5 different dental centers were considered for inclusion. Included records were subjected to statistical analysis of survival rates, along with a number of other patient-, implant-, surgery-, and prosthesis-related variables. Results: The inclusion criteria were met by 369 patients who received a total of 527 implants. The follow-up averaged 53.2 months (range 0.9-158.3) for implants placed into non-infected sockets (N = 334) and 50.1 months (range 1.6-146.1) for those placed into infected sites (N = 193). Seven implants failed in non-infected sites and 3 in infected ones. All failures occurred within 1 year of placement. Cumulative implant survival rate for non-infected and infected sites was, respectively, 97.9% ± 0.8% and 98.4% ± 0.9%, being not significantly different (P = .66). None of the investigated variables affected the outcome. Conclusions: Placement of implants into periodontally or endodontically infected sites immediately after tooth extraction is a safe option, even when the implants are loaded immediately or early.
Chapter
Our patients lose teeth due to advanced periodontal disease, endodontic issues, restorative problems, and trauma. The goal of the dental team that is treating the patient, should be to have the best procedures and materials used to maximize the functional and aesthetic benefits of each and every step of the process. From choosing the appropriate surgical technique to the proper materials will enable the regeneration of an ideal site with vital bone and covered with keratinized tissue. In this way an ideal implant can be placed to support a restoration which is easy to maintain in a clean and healthy state for the rest of the patient’s lifetime. This chapter will demonstrate different surgical approaches and biomaterials to help the surgeon make the best educated choice to yield an optimal biologically based, cosmetic outcome. The reader will see clinical cases, histologic validation, and literature source to justify the treatment modalities shown. These are predictable and will assist you in the choices you must make on a daily basis.
Article
Background: The purpose of the present study was to evaluate fresh socket implant outcome leaving granulomatous tissue into the bone defects. Materials and methods: Subjects requiring tooth extractions in periodontal infected sites were selected for this prospective study. Only patients with 4-wall defects and asymptomatic ones were included. The fresh sockets were randomly scheduled into two groups: In one group (Removal Group, RG) granulomatous tissue was removed and, in the other group (Left Group, LG) granulomatous tissue was left. Implants were positioned immediately after tooth extraction, and were loaded after 3 months in both groups. Intraoral digital radiographs were performed at temporary prosthesis placement; at 12, 24 and 36 months to evaluate marginal bone levels changes. Moreover, clinical parameters were acquired at the same time points. Results: Sixty patients were included in this study. Three-hundred seventy-two implants were placed immediately after tooth extraction and, at 3-year follow-up, a survival rate of 98.66% was reported, 2 implants were lost in RG and 3 implants in LG. At 36-month follow-up, not statistically significant differences were found between RG and LG in marginal bone level changes and clinical parameters (p > 005). Moreover, not statistically significant differences were found in intragroup comparisons over time (p > 0.05). Conclusions: With the limits of this study it was concluded that granulomatous tissue left in infected fresh sockets doesn't injury dental implant outcome.
Article
Background: There is paucity in the studies with long-term outcomes of the immediate loading of dental implants immediately placed into infected sites. This study aims to evaluate the long-term outcomes of immediate loading of post-extraction implants placed in infected sites. Methods: Patients were selected if having post-extraction implants in the anterior maxilla that were inserted between December 2006 to June 2015 and were immediately loaded. Information were collected about patient's demographic data, implant details, soft tissue stability and prosthodontic data. The marginal bone loss, implant and prosthesis survival rates were calculated. Results: A total of 30 patients (mean age 56 years) had 43 implants that were immediately inserted into infected sites and were immediately loaded. The implants were inserted at a torque value ≥ 35 Ncm. The mean follow-up time was 6 years (range 1 to 8 years) and 65% of the implants had a follow-up time > 5 years. No implant failure occurred and the implant success rate was 93%. The proximal bone loss was 1.42 mm (range: 0.21 to 5.61 mm). Three prosthetic complications (all fracture of the veneer material) occurred. Conclusions: The immediate loading of implant inserted into fresh and infected extraction socket has not been a risk factor for implant survival. However, the stability of the peri-implant soft and hard tissues has indicated the need to take measures that minimize their loss.
Article
Objectives: The aim of this study was to assess the microbiological and clinical outcomes of immediate implants placed in chronically infected sockets for rehabilitation with fixed full-arch mandibular prostheses. Material and methods: Fourteen individuals (mean age 60.14 ± 7.69 years) were enrolled in this investigation and followed up until 8 months of function. Microbiological (microbial count and profile) and clinical (probing depth, clinical attachment level, bleeding on probing, and bone resorption) parameters were conducted before teeth extraction (T0 - baseline) and after 4 (T1 ) and 8 (T2 ) months of loading. Thirty-nine microbial species including periodontopathogenic species and Candida spp. were detected and quantified by DNA checkerboard analysis. Results: Moderate to high levels of pathogenic and non-pathogenic species were found colonizing teeth and implant-related sites. No significant differences in total or individual microbial counts and microbial profile were found over time (P = 0.4929). Probing depth values from teeth (T0 : 3.05 ± 1.45) were significantly higher when compared with implants (T1 : 1.81 ± 0.56; T2 : 1.66 ± 0.53; P < 0.0001). High percentages of bleeding sites were found for both teeth and implants, with the highest values recorded for teeth (P < 0.05). No significant differences were detected comparing marginal bone resorption over time. Conclusions: Total and individual counts of target species did not differ between teeth and implants for 8 months of investigation. The mean proportions of pathogenic and non-pathogenic species remained unaltered, and no clinical complications were reported over time. Data obtained suggest that immediate loading of complete mandibular prostheses retained by implants placed immediately after extraction may be a viable treatment option for edentulous individuals with previous history of periodontal disease.
Article
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Purpose: This 1-year prospective study evaluated the implant success rate, peri-implant tissue response, and esthetic outcome of immediately placed and provisionalized maxillary anterior single implants. Materials and Methods: Thirty-five patients (8 men, 27 women) with a mean age of 36.5 years (range 18 to 65) were included in this study. Thirty-five threaded, hydroxyapatite-coated implants were placed and provisionalized immediately after each failing tooth had been removed. The definitive restoration was placed 6 months later. The patients were evaluated clinically and radiographically at implant placement and at 3, 6, and 12 months after implant placement. Results: At 12 months, all implants remained osseointegrated. The mean marginal bone change from the time of implant placement to 12 months was-0.26 ± 0.40 mm mesially and-0.22 ± 0.28 mm distally. No significant differences in the Plaque Index scores were noted at different time intervals. The mean midfacial gingival level and mesial and distal papilla level changes from pretreatment to 12 months were-0.55 ± 0.53 mm,-0.53 ± 0.39 mm, and-0.39 ± 0.40 mm, respectively. All patients were very satisfied with the esthetic outcome and none had noticed any changes at the gingival level. Discussion: Although marginal bone and gingival level changes were statistically significant from pretreatment to 12 months of follow-up, they were well within clinical expectations. Conclusion: The results of this study suggest that favorable implant success rates, peri-implant tissue responses, and esthetic outcomes can be achieved with immediately placed and provisionalized maxillary anterior single implants. (INT J ORAL MAXILLOFAC IMPLANTS 2003;18:31-39)
Article
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This multicenter study was conducted to determine the predictability for implants placed into immediate extraction sockets and augmented with e-PTFE barrier membranes. Forty-nine implants were placed in immediate extraction sockets. Initial and final defect measurements and the number of threads exposed were compared. Patients were followed up to 1 year after implant loading. Three implants were lost at the abutment connection surgery. The 1-year survival rate was 93.9%. Twenty barrier membranes became exposed and were removed prior to stage 2 surgery, while the remaining barriers were removed at abutment connection. The average defect bone formation for membrane-retained sites was 4.8 mm, while the average bone formation for sites in which the membranes were prematurely removed was 4.0 mm (P < .0001). At stage 2 surgery there was an average of 0.6 threads exposed (P < .001) for the membrane-retained sites and 2.6 threads for the early removal sites (NS). Forty-five pairs of nonstandardized radiographs were evaluated for bone loss after implant loading (average 7.5 months). The mesiodistal bone loss averaged 0.72 mm. Within the limits of this study, e-PTFE membranes will promote clinically and statistically significant amounts of bone around immediately placed implants. Retention of e-PTFE barriers until stage 2 surgery improves the amount of bone promoted around the implants.
Article
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The placement of implants allows for re-establishment of function and esthetics following tooth loss. Immediate implant placement is a relatively recent procedure and has advantages, such as reduced number of surgical procedures, preservation of alveolar bone, reduction of cost and period of edentulism, and increased patient acceptance. However, there are some specific contraindications for the technique, such as the presence of an infection caused by periodontal disease and periapical lesions. The objective of this study was to evaluate the percentage of bone-implant contact of immediate implants placed in periodontally infected sites. In the first phase, periodontitis was induced with ligatures in the mandibular premolars of 5 mongrel dogs, using the contralateral teeth as controls (received prophylaxis only). After 3 months, in the second phase of the study, 40 implants were placed in the alveoli of both experimental and control teeth. After a healing period of 12 weeks, the animals were euthanized, and the hemimandibles were removed, dissected, fixed, and prepared for histomorphometric analysis of percentage of bone-implant contact. The Mann-Whitney test was used for statistical analysis. The results of the histomorphometric analysis indicated mean bone-implant contact of 62.4% in the control group and 66.0% in the experimental group, a difference that was not statistically significant. Histomorphometric results revealed similar bone-implant contact in both groups, with no signs of infection. It was concluded that periodontally infected sites may not be a contraindication for immediate implantation in this animal model system, if adequate pre- and postoperative care is taken.
Article
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Preservation of alveolar bone volume following tooth extraction facilitates subsequent placement of dental implants and leads to an improved esthetic and functional prosthodontic result. The aim of the present study was to assess bone formation in the alveolus and the contour changes of the alveolar process following tooth extraction. The tissue changes after removal of a premolar or molar in 46 patients were evaluated in a 12-month period by means of measurements on study casts, linear radiographic analyses, and subtraction radiography. The results demonstrated that major changes of an extraction site occurred during 1 year after tooth extraction.
Article
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Polychromatic sequence labeling of bone was used to study the effect of periodontal infection on the immediate placement of Frialit-2 implants. In the surgical first phase, periodontitis was induced with ligatures involving the mandibular premolars of 5 mongrel dogs, and the contralateral teeth were used as controls (received only prophylaxis). After 3 months, the second phase was initiated and 40 implants were placed in the alveoli of both experimental and control teeth. During the healing period, fluorescent bone markers were injected to study bone formation around the implants. The dyes were injected in the following sequence: oxytetracycline hydrochloride at 3 days after implant placement, calcein green 4 weeks after implant placement, oxytetracycline 8 weeks after implant placement, and alizarin red S 3 days before sacrifice. Following a healing period of 12 weeks, the animals were euthanized and the hemimandibles were removed, dissected, fixed, and prepared for histomorphometic analysis of the percentage of each bone marker present. Fluorescence microscopy showed a similar sequence of bone remodeling (Mann-Whitney test) for both groups: experimental group, 9% bone formation at 3 days, 29% at 4 weeks, 21.6% at 8 weeks, and 52% at 12 weeks; control group, 14% at 3 days, 35.2% at 4 weeks, 32.3% at 8 weeks, and 45.8% at 12 weeks. Remodeling in both groups had similar characteristics in the degree of bone formation. It was concluded that periodontal disease does not affect bone remodeling around immediate implants. Although the healing in periodontally infected sites was slower initially, it reached the levels of the non-diseased sites after 12 weeks.
Article
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Some of the original surgical protocols for implant surgery have been reassessed to satisfy the patient's continuously increasing expectation for shorter rehabilitation time, improved esthetics, and increased comfort. The aim of this study was to evaluate the 12-month clinical success of 18 single-tooth implants inserted immediately after tooth extraction and restored the same day with non-functional loading. A total of 18 patients (12 women and six men), 22 to 60 years old, were enrolled in this study. Eighteen single implants were inserted in fresh extraction sockets and immediately restored with temporary abutments and crowns. All experimental sites showed an absence of fenestrations or dehiscences of the bone walls and a residual gap between implant surfaces and surrounding bone walls < or =2 mm. All temporary prostheses were positioned the same day of surgery and were not in occlusal contact with opposing arches. The comparison between the baseline and 12-month visits was performed with the Student t test for paired data (statistically significant at a level of alpha = 0.05). During the 12-month follow-up period, one fixture was removed 4 weeks after implant placement following an abscess. All remaining implants healed uneventfully with no complications and were assessed as stable and successful at the 12-month checkup. No technical complications such as screw loosening, resin fracture, or pain during chewing were registered during the 12-month period. Within the limits of the data from this study, it can be suggested that immediate placement and restoration of a single implant can be a valid and successful option of treatment in the case of single compromised teeth. Moreover, this treatment protocol eliminates the need for removable provisional restoration and seems to maintain the preexisting architecture of soft and hard tissues in most cases. Nonetheless, further prospective and long-term studies are required to obtain a better insight into the limitations of this protocol.
Article
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Placing implants in periodontally compromised sites is generally considered a risk factor. Good results have been reported when rehabilitating partial or complete edentulous sites in patients with a history of periodontitis. However, there is a need for more documentation of this treatment modality. The purpose of this study was to report, retrospectively, on the placement of implants in periodontally compromised areas of the maxilla and mandible without a prior healing period and in immediate function. This study also presents a prospective preliminary 1-year report using a standardized clinical protocol, including a regenerative surgical procedure, control of the inflammatory response, a maintenance protocol, and use of an implant with an oxidized surface. The clinical study encompassed 184 consecutively included patients with 433 implants (165 with a machined surface and 268 with an oxidized surface) placed in immediate function (140 in the maxilla and 293 in the mandible) supporting 218 fixed prostheses. Two groups were defined: the Retrospective group (using an unstandardized surgical technique and a majority of machined surface implants) with a retrospective approach and the Prospective group (using standardized surgical and maintenance protocols and oxidized surface implants) with a prospective approach. The 2 groups were evaluated for implant survival, clinical implant stability, bone resorption, absence of radiolucent areas around implants on the radiographs, and patient-reported function of the implants. Definitive prostheses were placed 6 months after the surgery. The data was analyzed using descriptive statistics. Thirteen implants were lost in 9 patients, providing a cumulative survival rate of 91% at 5 years for the Retrospective group. In the Prospective group, a 100% cumulative survival rate was recorded after 1 year. The average bone resorption (SD) was 1.2 mm (0.9 mm) and 1.1 mm (1.1 mm) after the first year for the Retrospective and Prospective groups, respectively, and 1.7 mm (1.0 mm) for the Retrospective group after the fifth year of function. The cumulative survival rate of 91% at 5 years for the Retrospective group is low compared to protocols for noncompromised situations, but the use of a standardized protocol together with oxidized surface implants seems to improve the treatment outcome and bring the survival rate to levels comparable to noncompromised situations.
Article
The philosophy of retaining natural teeth as long as possible for the preservation of alveolar bone has been a fundamental concept of dental treatment. With the introduction of predictable osseointegrated implant-supported prostheses, placement of an implant immediately after dental extraction can be considered. This paper discusses the technique of implant placement immediately following dental extraction. Clinical experience including 61 patients with follow-up of 1 to 6 years is reported.
Article
1. 1. Bone is a living tissue of varying size, shape, and density and is subject to constant remodeling throughout life. 2. 2. It is helpful in research, teaching, and patient care to classify adult mandibles into 6 orders of anatomic form: I, pre-extraction; II, postextraction; III, high, well-rounded residual ridge; IV, knife-edge residual ridge; V, low, well-rounded residual ridge; VI, depressed residual ridge. 3. 3. Microradiography of thin sections of bone shows clearly the variations in form and degree of mineralization of the various elements of bone. 4. 4. Microradiography of midsagittal sections of 21 edentulous mandibles revealed external resorption and an absence of periosteal bone on the residual ridges in all specimens. 5. 5. Evidence of mild to moderate osteoporosis was seen in one half of the specimens (average age of this group, 76 years). 6. 6. There are many avenues for the study of resorption of residual ridges. The possible roles of a constricting mucoperiosteum and of surgical technique are discussed.
Article
1.1. Bone is a living tissue of varying size, shape, and density and is subject to constant remodeling throughout life.2.2. It is helpful in research, teaching, and patient care to classify adult mandibles into 6 orders of anatomic form: I, pre-extraction; II, postextraction; III, high, well-rounded residual ridge; IV, knife-edge residual ridge; V, low, well-rounded residual ridge; VI, depressed residual ridge.3.3. Microradiography of thin sections of bone shows clearly the variations in form and degree of mineralization of the various elements of bone.4.4. Microradiography of midsagittal sections of 21 edentulous mandibles revealed external resorption and an absence of periosteal bone on the residual ridges in all specimens.5.5. Evidence of mild to moderate osteoporosis was seen in one half of the specimens (average age of this group, 76 years).6.6. There are many avenues for the study of resorption of residual ridges. The possible roles of a constricting mucoperiosteum and of surgical technique are discussed.
Article
The aim of this study was to report a clinical comparative assessment of crestal bone level change around single implants in fresh extraction sockets in the esthetic zone of the maxilla either immediately loaded or loaded after a delay. Forty patients were included in a prospective, randomized study. All patients required 1 tooth extraction (ie, 1 tooth with a hopeless prognosis) and were randomized into either the test group or the control group. Implants were positioned immediately after tooth extraction and were loaded immediately in the test group (20 implants) and after 3 months in the control group (20 implants). The implant site was prepared, with at least 4 mm of sound apical bone below the implant apex, and the coronal margin of the implant was placed at the buccal level of the bone crest. All implants were 13 mm long; 30 implants had a diameter of 5 mm, and 10 had a diameter of 3.75 mm. Radiographic examinations were made at baseline, at 6 months, and at 24 months. To compare the mean values between test and control group, a paired t test was performed (considered statistically significant at P < .05). After a 24-month follow-up period, a cumulative survival rate of 100% was reported for all implants. The control group resulted in a mean mesial bone loss of 1.16 +/- 0.32 mm and a mean distal bone loss of 1.17 +/- 0.41 (mean bone loss, 1.16 +/- 0.51 mm). The test group resulted in a mesial bone loss of 0.93 +/- 0.51 mm and a distal bone loss of 1.1 +/- 0.27 mm (mean bone loss, 1.02 +/- 0.53 mm). No statistically significant difference between control and test groups (P > .05) was found. The success rate and radiographic results of immediate restorations of dental implants placed in fresh extraction sockets were comparable to those obtained in delayed loading group.
Article
The origin of indices for recording gingivitis and plaque is reviewed. Each index seems to have been constructed for a special purpose. The development so far has been towards more and more delicately graded indices which are well suited for evaluation of short term clinical trials. The increased sensitively, though advantageous for scientific purpose, is not always practical from a public dental health point of view. It seems that at present there is a need for several different types of index systems. In order to be able to conduct his preventive programs the practicing dentist needs a simple and well defined recording system for oral hygiene and gingival inflammation. Such an index system should be as easy and natural to use as is the scoring of decayed and filled surfaces today. Instead of using individual mean scores of multi-graded plaque and gingival indices, the use of the site prevalence of a single finding is suggested. For recording of gingivitis in daily dental practice the number of gingival margins bleeding on pressure is recommended to be determined as a percentage of the sites examined (Fig. 1,2 and 3). For oral hygiene, correspondingly, the frequency of occurrence of tooth surfaces covered with clearly visible plaque could be used as a clinically relevant parameter (Fig. 4). Keeping visible plaque and gingival bleeding away is also suggested to be a clearly understandable and practical aim in the dental health education of the individual patient.
Article
Twelve 10 mm implants were placed into immediate extraction sockets in dogs. Six implants were isolated with PTFE membranes and 6 sites served as controls. Standardized clinical measurements were taken at test and control sites. At 18 weeks the dogs were anesthetized and flaps were laid for the purpose of obtaining clinical measurements. The average gain of bone around augmented implants was 2.6 mm, while control sites had an average bone gain of 1.0 mm. Ridge width adjacent to augmented sites increased by 1.2 mm and control sites had an increased width of 0.6 mm. Histologic evaluation of test and control specimens showed greater bone formation around augmented implants. Implants augmented with PTFE membranes had clinically significant amounts of bone regeneration when compared with controls.
Article
In order to satisfy the need to restore the aesthetics, phonetics and comfort and to facilitate optimal hygiene procedures, 20 edentulous patients were treated with a new concept of overdenture therapy on implants and modum Brånemark. After 24 +/- 3.5 months the patients were re-examined. They were asked to answer a questionnaire and use a Visual Analogue Scale (VAS) to give their opinion on the prosthetic treatment. The results indicate that an implant-retained overdenture in the maxilla with this design can satisfy the patients needs in aesthetics, phonetics and comfort and can facilitate oral hygiene measures.
Article
In 51 patients (21 males and 30 females) aged 16 to 72 years, a total of 109 Nobelpharma implants were placed into extraction sockets immediately following extraction. The follow-up period varied between 1 and 67 months with a mean of 30.5 months. Osseointegration was determined by clinical stability, lack of symptoms, and lack of peri-implant pathology based on radiographic examination. The implant survival rate was 93.6%. Six implants were mobile at the abutment connection stage, and one was lost when function commenced. The success rate was 92.0% for implants replacing teeth extracted because of periodontitis and 95.8% for implants replacing teeth extracted for other reasons. Two other complications occurred: 12 cover screws perforated the gingiva during healing; and infection developed in five cases. The incidence of infection was higher in the periodontitis group. It was found that immediate placement of implants into extraction sockets is a safe and predictable procedure if certain guidelines are followed.
Article
The study the effect of chronically infected sites on the immediate placement of implants, periapical lesions were induced in the third and fourth premolars of four dogs and the contralateral teeth were used as controls. Nine months after the induction of periapical lesions, experimental and control teeth were extracted, and 28 IMZ implants were immediately placed. After a healing period of 12 weeks, the animals were sacrificed, the hemimandibles were removed, and specimens were prepared to be hard-sectioned and stained with toluidine blue. All areas healed without inflammation or exudation and all implants were clinically immobile and were radiographically determined to be surrounded by normal-appearing bone. Histologically, there were no signs of infection, and the histomorphometric analyses revealed that 28.6% and 38.7% had osseointegrated for the experimental and control implants, respectively. The difference was not statistically significant. It was concluded that chronically infected sites, such as those showing signs of periapical pathosis, may not be a contraindication for immediate implants, if certain clinical measures and preoperative and postoperative care are taken.
Article
Five titanium plasma-sprayed implants were biopsied from a human volunteer 6 months after placement. Four test implants had been placed in immediate extraction sockets, while one implant was placed in a mature site and served as a control. The histologic analysis demonstrated that all five implants achieved osseointegration as demonstrated by light microscopy, whereas a varying degree of bone-implant contact was observed. The non-loaded control implant had the highest percentage of bone-implant contact, 72%, followed by the two implants placed in the canine sites presenting with a horizontal defect dimension of 1.5 nm or less. These implants were placed without a barrier membrane, but in a submerged fashion. The histometric analysis showed a mean bone-implant contact of 50% for these two implants. The lowest mean bone-implant contact (17%) was observed for the two molar implants, which had horizontal defect dimensions of 4 mm; these implants were placed in a non-submerged fashion with the implants perforating an expanded polytetrafluoroethylene membrane. The authors concluded that osseointegration may occur in immediate extraction sites in humans using titanium implants with a plasma-sprayed surface. The horizontal component of the peri-implant defect was apparently the most critical factor relating to the final amount of bone-implant contact.
Article
This 1-year prospective study evaluated the implant success rate, peri-implant tissue response, and esthetic outcome of immediately placed and provisionalized maxillary anterior single implants. Thirty-five patients (8 men, 27 women) with a mean age of 36.5 years (range 18 to 65) were included in this study. Thirty-five threaded, hydroxyapatite-coated implants were placed and provisionalized immediately after each failing tooth had been removed. The definitive restoration was placed 6 months later. The patients were evaluated clinically and radiographically at implant placement and at 3, 6, and 12 months after implant placement. At 12 months, all implants remained osseointegrated. The mean marginal bone change from the time of implant placement to 12 months was -0.26 +/- 0.40 mm mesially and -0.22 +/- 0.28 mm distally. No significant differences in the Plaque Index scores were noted at different time intervals. The mean midfacial gingival level and mesial and distal papilla level changes from pretreatment to 12 months were -0.55 +/- 0.53 mm, -0.53 +/- 0.39 mm, and -0.39 +/- 0.40 mm, respectively. All patients were very satisfied with the esthetic outcome and none had noticed any changes at the gingival level. Although marginal bone and gingival level changes were statistically significant from pretreatment to 12 months of follow-up, they were well within clinical expectations. The results of this study suggest that favorable implant success rates, peri-implant tissue responses, and esthetic outcomes can be achieved with immediately placed and provisionalized maxillary anterior single implants.
Article
Implants placed immediately after tooth extraction have shown high percentages of clinical success. Few studies in the scientific literature have observed the horizontal bone remodeling in the buccal-lingual direction after immediate placement of implants. The aim of this study was to analyze bone healing and coronal bone remodeling around 15 implants placed immediately after tooth removal without the use of guided bone regeneration (GBR) techniques. Ten patients received a total of 15 implants placed immediately after removal of 15 single-rooted teeth. All implants were placed within the alveolar confines, limiting, in most cases, small peri-implant bone defects. After implant placement, the distance from the buccal to lingual bone plate was measured. No membranes or filling materials were used. Primary flap closure was performed in all cases. At second-stage surgery, all peri-implant defects were completely filled and the distance from buccal to lingual bone was measured again. The pattern of bone healing around the neck of immediate implants showed an absence of peri-implant defects and a narrowing of bone crest width in a buccal-lingual direction. The mean distance between buccal bone and lingual bone at the time of implant placement was 10.5 mm (+/- 1.52) and, at second-stage surgery, 6.8 mm (+/- 1.33). The coronal bone remodeling around immediate implants showed a healing pattern with new bone apposition around the neck of the implants and, at the same time, bone resorption with horizontal width reduction of the bone ridge. The small peri-implant bone defects were completely healed without the use of GBR procedures. An absence of complications during the healing period was also observed, probably due to the absence of barrier membranes and grafting materials.
Article
The purpose of this study was to assess the survival rates and interproximal bone levels for Osseotite implants that were restored with fixed provisional crowns without occlusion immediately after implant placement. Ninety-three implants were placed in 38 partially edentulous patients. All implants were immediately restored with prefabricated abutments and cement-retained provisional crowns without centric or eccentric occlusal contacts. The implants were restored with definitive restorations approximately 8 to 12 weeks after implant placement. All patients included in the study were followed for at least 18 months after implant placement (average 20.3 months). Seventy-seven of the 93 implants satisfied the inclusion criteria. Seventy-five implants became osseointegrated. The overall survival rate was 97.4%. Radiographic bone loss 18 months after implant placement (the mean of both interproximal surfaces) was 0.76 mm. The exact binomial confidence interval was 0.32% to 9.07%. For the exact binomial test with the null hypothesis proportion = .05, P was .3334 and was not statistically significant. Immediate nonocclusal loading of single-unit dental implants differs from immediate loading of multiple, splinted implants. Unsplinted, restored implants without occlusal loading may still be subject to lateral and occlusal loads secondary to the proximate location of the food bolus. Immediate restoration of dental implants significantly reduces treatment time and may be beneficial in reducing the morbidity associated with loss of teeth, contraction of the alveolus, and loss of interdental papillae associated with the traditional method of treatment following tooth loss. The results of this study suggest that immediate restoration of Osseotite implants can be accomplished with results that are similar to the results obtained with the traditional 1- or 2-stage surgical, unloaded healing protocols.
Article
The marginal gap that may occur following implant installation in an extraction socket may be resolved by hard-tissue fill during healing. To study dimensional alterations of hard tissues that occur following tooth extraction and immediate placement of implants. Eighteen subjects with a total of 21 teeth scheduled for extraction were included. Following flap elevation and the removal of a tooth and implant installation, clinical measurements were made to characterize the dimension of the surrounding bone walls, as well as the marginal defect. No membranes or filler material was used. The flaps were subsequently replaced and secured with sutures in such a way that the healing cap of the implant was exposed to the oral environment. After 4 months of healing a re-entry procedure was performed and the clinical measurements were repeated. Fifty-two marginal defects exceeding 3 mm were present at baseline: 21 at buccal, 17 at lingual/palatal, and 14 at approximal surfaces. At the re-entry eight defects exceeding 3.0 mm remained. During the 4 months of healing, the bone walls of the extraction underwent marked change. The horizontal resorption of the buccal bone dimension amounted to about 56%. The corresponding resorption of the lingual/palatal bone was 30%. The vertical bone crest resorption amounted to 0.3+/-0.6 mm (buccal), 0.6+/-1.0 mm (lingual/palatal), 0.2+/-0.7 mm (mesial), and 0.5+/-0.9 mm (distal). The marginal gap that occurred between the metal rod and the bone tissue following implant installation in an extraction socket may predictably heal with new bone formation and defect resolution. The current results further documented that marginal gaps in buccal and palatal/lingual locations were resolved through new bone formation from the inside of the defects and substantial bone resorption from the outside of the ridge.
Article
Infection in tooth extraction sites has traditionally been considered an indication to postpone implant insertion until the infection has been resolved. The aim of this study was to evaluate the survival rate of early-loaded implants placed immediately after extraction of teeth with endodontic and periodontal lesions in the mandible. Twenty patients in need of mandibular implant treatment and with teeth showing signs of infection in the interforaminal area were included in the study. The patients received four to six implants (Brånemark System, Nobel Biocare AB, Göteborg, Sweden) in or close to the fresh extraction sockets and received a provisional prosthesis within 3 days. Final prostheses were delivered after 3 to 12 months. The surgical protocol paid special attention to the preservation of high implant stability and control of the inflammatory response. The patients were followed up for 15 to 44 months. No implants were lost, resulting in a 100% survival rate. A mean marginal bone loss of 0.7 mm (SD 1.2 mm) was registered during the observation period. No signs of infection around the implants were detected at any follow-up visit. A high survival rate can be achieved for immediately placed and early-loaded implants in the mandible despite the presence of infection at the extracted teeth.
Article
The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns. A series of 22 cases with a 12-month follow-up is presented. Twenty-two patients (15 women and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical or horizontal root fracture, caries, endodontic lesions, or periodontal disease were treated with immediate postextraction implant placement. The implant was then restored with a screw-retained prosthetic restoration within 24 hours. Radiographic assessments were made at baseline and 12 months after implant placement. Clinical parameters, such as plaque score, mucositis score, probing attachment level, mucosal margin position, variation of gingival level, and variation of papilla position, were also measured at baseline and after 12 months of follow-up. At 12 months, no implants had failed. Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline. The mean variation of gingival level, compared to the neighboring teeth, was -0.75 mm. Probing attachment levels were 0.79, 0.45, and 0.54 mm at proximal, buccal, and lingual sites, respectively. The values for the mucosal margin position were 2.9, 2.2, and 2.4 mm at proximal, buccal, and lingual sites, respectively. Regarding variation of papilla position, according to Jemt's index, 27 papillae presented with a score of 2 (61%) and 17 with a score of 3 (39%). An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13%. Furthermore, mucositis (score 2) was not observed at any of the peri-implant units. Primary implant stability did not significantly increase over time. The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure. The success rate and radiographic and clinical results were comparable to those obtained following the standard protocol. Within the limits of the present investigation, immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth. However, long-term clinical trials are needed to confirm the present results.
Article
Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics. Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery. Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plaque index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months. The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P <0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P >0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P >0.05). The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single-tooth implants either immediately or delayed loaded. Other long-term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study.
Article
To determine clinical success when implants are placed in chronic periapical infected sites. Fifty patients (25 females, 25 males, mean age 39.7 +/- 14.5 years) were included in this prospective controlled study. After randomization, 25 Frialit-2 Synchro implants were immediately placed (IP) after extraction, and 25 Frialit-2 Synchro implants were placed after a 3-month healing period (DP). Thirty-two implants were placed in the anterior maxilla and 18 implants were placed in the premolar region. Implant survival, mean Implant Stability Quotient (ISQ) values, gingival aesthetics, radiographic bone loss, and microbiologic characteristics of periapical lesions were evaluated for both groups. Overall, 2 implants belonging to the IP group were lost, resulting in a survival rate of 92% for IP implants versus 100% for DP implants. Mean ISQ, gingival aesthetics and radiographic bone resorption, and periapical cultures were not significantly different with the IP and DP implants. Immediate implant placement in chronic periapical lesions may be indicated.
Article
Infection in tooth extraction sites has traditionally been considered an indication to postpone implant placement until the infection has been resolved. The aim of this study was to evaluate the survival rate of immediate and early-loaded implants placed immediately after extraction of teeth with endodontic and periodontal lesions or root fracture in the maxilla. Thirty-three patients with teeth judged to be unrestorable because of endodontic or periodontal lesions or root fracture were included in the study. After tooth extraction, 1 to 6 implants (n=76) were placed in each patient using flap or flapless surgery in fresh extraction sockets, and a fixed provisional prosthesis was placed immediately or within 36 hours. Definitive prostheses were inserted after 6 to 12 months. The treatment protocol considered initial implant and prosthesis stability and control of the inflammatory response. Clinical and radiographic analyses were performed to evaluate the treatment outcome. Data were reported using descriptive statistics. After 1 year, 2 implants were lost, resulting in a 97.4% survival rate. A mean (SD) marginal bone loss of -0.91 (1.50) mm was recorded during the observation period. No signs of infection around the implants were detected at any follow-up visit. There was a tendency towards less bone loss with the flapless protocol, -0.74 (1.34) mm, versus flap, -1.02 (1.60) mm, and less bone loss for single, -0.55 (1.52) mm, versus multiple restorations, -0.86 (1.24) mm, with the flapless approach. A high 1-year survival rate was achieved for immediately placed and immediately/early-loaded implants in the maxilla, despite the presence of infection in the location of the extracted teeth.
Article
The aim of the present study was to test whether or not immediate implantation leads to more biological complications, when performed at extraction sockets of teeth exhibiting periapical pathology compared with teeth not exhibiting periapical pathology. In 17 consecutively admitted patients, immediate implant placement was planned in order to replace single teeth exhibiting periapical pathology (test group). These teeth demonstrated pain, periapical radiolucency, fistula, suppuration or a combination of these findings. Another 17 consecutively admitted patients in need of single tooth replacement in the absence of periapical pathology served as the control group. Implant placement and accompanying bone regeneration were performed according to standard clinical procedures. Implants were loaded after a healing period of 3 months. Clinical and radiographical parameters were assessed at the time of implant placement (baseline) and at 12 months thereafter. Out of the 34 patients, four test and one control patient had to be withdrawn from the study due to the inability to obtain primary implant stability. The residual 29 implants revealed a survival rate of 100% 1 year after placement. Clinical and radiographical differences between 12 months and baseline comparing test and control groups showed no statistical significances for any of the parameters assessed. Within test and control groups there was a statistically significant loss of vertical bone height at the adjacent teeth (mesial test=0.4+/-0.6 mm, control=0.4+/-0.5 mm; distal test=0.3+/-0.2 mm, control=0.7+/-0.8 mm) as well as at the implant site (mesial test=1.9+/-1.4 mm, control=1.8+/-1.1 mm; distal test=1.7+/-1.4 mm, control=1.6+/-1.1 mm) and of buccal keratinized mucosa (test=-2.2+/-1.2 mm; control=-1.3+/-1.6 mm) between baseline and 12 months. During the first 13 weeks of healing, two sites of the test and one site of the control group showed signs of infection, which required intervention. Neither the incident of early exit nor of signs of infection was statistically significantly different between the test and the control group (Mann-Whitney U test). It is concluded that for those implants where primary stability was achieved, the immediate implant placement performed at extraction sockets exhibiting periapical pathology did not lead to an increased rate of complications and rendered an equally favorable type of tissue integration of the implants in both groups. Implant placement into such sites can, therefore, be successfully performed.
Article
The aim of this study was to evaluate the clinical and radiographic outcome of dental implants immediately placed and loaded into fresh extraction sockets after 18 months. Twenty-seven patients, 15 women and 12 men, received a total of 160 implants; 150 were placed immediately after extraction. The sockets in the study had fully preserved walls, and 10 were placed in healed sites. Immediately after surgical procedure, all patients received the temporary prosthetic reconstruction in occlusion. Five months postsurgery, definitive metal-ceramic restorations were cemented on abutments. Follow-up visits were performed for the assessment of clinical parameters. Intraoral digital radiographic examinations were performed 3 and 18 months after implant placement. Minor swelling of the gingival mucosa was observed, but no mucositis or flap dehiscence with suppuration were found. Mean marginal bone loss 1 year 18 months after immediate loading was 0.65 +/- 0.58 mm to the mesial side and 0.84 +/- 0.69 mm to the distal side in the maxilla and 1.13 +/- 0.51 mm mesially and 1.24 +/- 0.60 mm distally in the mandible. There was no difference between splinted and nonsplinted implants with respect to marginal bone loss. Discussion and Within the limits of this clinical study, the results indicate that immediate loading of implants placed in immediate extraction sites can be carried out successfully. (Case Series)
The diagnosis and treatment of periimplantitis
  • A Mombelli
  • N P Lang
Mombelli A, Lang NP. The diagnosis and treatment of periimplantitis. Periodontol 2000 1998;17:63-76.